"Surrogacy is an important family planning option, but be prepared for a lengthy, expensive and emotional process."
By David Dodge| April 17, 2020
"This guide was originally on October 11th 2019 in NYT Parenting."
"From the time they began dating as teenagers, Rita and Erikson Magsino, now 39 and 43, talked about the family they hoped to have together one day. Almost immediately after marrying in 2005, they tried to make that dream a reality.
But parenthood would have to wait — Magsino learned she had an aggressive form of endometriosis that made it difficult for her to become pregnant. For over a decade, the couple tried everything to conceive — including fertility drugs and advanced treatments like intrauterine insemination and in vitro fertilization. Twice, Magsino became pregnant, only to miscarry late in the second trimester. “After we lost twins at 20 weeks, we decided enough was enough,” she said. A generation ago, the couple’s attempts to have a biological child most likely would have ended there. Instead, thanks to improvements in reproductive medicine, they welcomed a baby boy into their home in May with the help of a gestational surrogate.
Surrogacy has also created an avenue to biological parenthood for thousands of others who can’t conceive or carry children on their own, such as same-sex couples and single men. As a gay, H.I.V.-positive man, Brian Rosenberg, 54, figured biological fatherhood was forever out of reach. But thanks to surrogacy, and a technique known as “sperm washing,” which prevents H.I.V. transmission, he and his husband, Ferd van Gameren, 59, welcomed twins, biologically related to Rosenberg, in 2010. “It’s still hard to believe,” Rosenberg said. “I thought this was a door that was shut to me.”
Still, would-be parents need to be prepared for a process that is far longer, more expensive and emotional than many people expect — it’s called a “surrogacy journey” for a reason. For this guide, I interviewed the types of experts you can expect to encounter during a surrogacy journey, including two fertility specialists, a lawyer, a psychologist and an agency caseworker."
May 19, 2020 in Policy
"A new Center for Disease Control (CDC) study finds that around 1 in 8 women report experiencing symptoms of maternal depression. The analysis, which looked at 2018 Pregnancy Risk Assessment Monitoring Survey (PRAMS) data from 30 states and Puerto Rico, found that rates of “postpartum depression” symptoms ranged from a little under 10% in Illinois to almost 24% in Mississippi.
The majority of women reported making at least one visit to their physician after giving birth, and most reported being asked about their mental health during this visit. But this also varied by location: Women in Vermont were almost always asked about their mental health, while those in Puerto Rico were among the least likely to be asked. At the same time, women who were younger than 19, or white or Pacific Islander, or had a history of depression during prenatal visits were more likely to be asked about depression during a postpartum visit."
"Miscarriage happens in up to 15 percent of pregnancies. Why aren’t we talking about it?"
By Jyoti Madhusoodanan| April 16, 2020
Photo: Kit Agar
"Lizette Galvan’s home pregnancy test was positive a few days after her expected period. But at her first ultrasound, she heard the words: “This is where the heartbeat should be.” Just six weeks into her first pregnancy, Galvan — like approximately one in 10 pregnant women — had miscarried.
Most early pregnancy losses occur within the first 12 weeks. Although the risk drops with each passing week, a miscarriage can occur any time until the 20-week mark. (Later losses are considered stillbirths.) About 10 to 15 percent of all pregnancies end in such an early loss, according to the American College of Obstetricians and Gynecologists. “Miscarriage is the most common complication in pregnancy,” said Dr. Courtney Schreiber, M.D., an associate professor of obstetrics and gynecology at the University of Pennsylvania. “Many occur even before a woman has connected with a prenatal care provider.”
Thanks to improved home tests, women like then 38-year-old Galvan learn sooner than ever if they’re expecting. “In the past, women would not even have known about a lot of pregnancies that would’ve ended in a miscarriage,” said Dr. Pamela Geller, Ph.D., an associate professor of psychology, ob-gyn and public health at Drexel University in Philadelphia. “They might have had a bit of pain and bleeding but would have just thought of it as a heavy menstrual cycle.”
This early knowledge also means more women grapple with the emotional consequences of early pregnancy loss — which are often no different than the grief of losing a loved one.
For this guide, I read through the science, and spoke with three practicing ob-gyns and a researcher who studies miscarriages to help you understand early pregnancy loss, treatment options and ways to optimize recovery."
By: Karen Kleiman
"The awesome responsibility of caring for a newborn naturally warrants a heightened sense of vigilance. Sometimes this necessary state of watchfulness can be confusing. At every turn, a new mother believes a crisis is looming. Afraid of slipping and dropping the baby, she holds them extra tightly while she goes down the stairs. Afraid of a disaster in the night, she keeps herself awake to hear the silent sounds of breathing. If she falls asleep from sheer fatigue, she dreams of causing the baby harm through her own negligence.
Here are some reasons why postpartum women don't share these scary thoughts:
1. The ambiguity factor
One reason why postpartum women don't talk about the thoughts that are having is that they are not sure what is "normal" and what may be problematic. This is due to the overlapping experiences between women with postpartum anxiety or depression and women with no such diagnosis.
For example: fatigue, loss of libido, moodiness, weepiness, changes in weight, sleep disturbance, and low energy can all be attributed to anxiety and depression, yet they are also considered to be within normal expectations for postpartum adjustment. Because moods and other internal experiences are expected to fluctuate following childbirth, women sometimes decide it is best to brave any discomfort and hope it goes away by itself.
Unfortunately, scary thoughts are not easy to ride out. What's more, without proper assessment, a woman's worry about these thoughts can rapidly disintegrate from initial concern to panic.
2. The critical inner voice
The shame that can accompany upsetting thoughts is unbearable. What is wrong with me? How can I be thinking these things? Good mothers don't think such terrible thoughts. Often, the only explanation that makes sense to a mother who is trying to reconcile this disturbing experience is that there is something profoundly wrong with her, something is broken inside. Maybe she is close to insanity. Or maybe she is not fit to be a mother. Either option, or anything in between, is a nightmare. This nightmare stuns many women into silence. They hope that if they can just hold their breath and carry off this role-play, their awful thoughts will somehow go away. In some instances, the thoughts actually do go away. Usually, they do not.
Other women tirelessly try to push the thoughts out of their minds, but are distraught when the thoughts return in full force. Some women can express the horror of their thoughts along with the abysmal shame that accompanies them, but, for many, the actual articulation of the specific thoughts, the words they fear would somehow make the thoughts come alive, remain locked inside.
Women say they are embarrassed, ashamed, mortified, humiliated and guilty beyond description. They say they feel hideously exposed, naked, repulsive, raw, nauseous, ugly and sickened by their own thoughts. Some say they feel so appalled by the nature of their thoughts that they feel inhuman, as if only a monster could possess and admit such atrocities.
An important point here is that high level of distress indicates that the scary thoughts are ego-dystonic, or incompatible with the woman's sense of herself. Although it is never easy to experience such high levels of distress, there is considerably more concern when a woman expresses no such distress or displays no strong affect attached to this worry. Thus, a woman's agitation is often a signal that anxiety is the mechanism at work and not something more worrisome, like psychosis. Knowing this can reassure both the distressed mother and her healthcare provider.
Shame-based barriers to disclosing one's thoughts can be fueled by the critic inside one's own head. With regard to the critical inner voice, mothers report they are reluctant to reveal scary thoughts because they:
By Jennie Agg| May 5, 2020
"After losing four pregnancies, Jennie Agg set out to unravel the science of miscarriage. Then, a few months in, she found out she was pregnant again – just as the coronavirus pandemic hit"
"I stepped out of Oxford Circus tube into mid-morning crowds and cold, bright sunshine. The consultant’s words were still ringing in my ears. “Nothing.” How could the answer be nothing? This was January 2018, six months since my third miscarriage, a symptomless, rather businesslike affair, diagnosed at an early scan. The previous November, I’d undergone a series of investigations into possible reasons why I’d lost this baby and the two before it.
That morning, we had gone to discuss the results at the specialist NHS clinic we’d been referred to after officially joining the one in 100 couples who lose three or more pregnancies. I had barely removed my coat before the doctor started rattling off the things I had tested negative for: antiphospholipid antibodies, lupus anticoagulant, Factor V Leiden, prothrombin gene mutation.
“I know it doesn’t feel like it, but this is good news,” he said, while the hopeful part of me crumpled. We were not going to get a magic wand, a cure, a different-coloured pill to try next time.
Now, my husband, Dan, was back at work and, for reasons I can’t really explain, I had decided to take myself shopping rather than go home after the appointment. I stood staring down the flat, grey frontages of Topshop and NikeTown and willed my feet to unstick themselves from the pavement.
I ended up wandering the beauty hall of one of London’s more famous department stores. I let myself be persuaded to try a new facial, which uses “medical-grade lasers” to evaporate pollution and dead skin cells from pores to “rejuvenate” and “transform” your complexion. Upstairs in the treatment room, the form I was handed asked if I’d had any surgery in the past year. I wrote in tight, cramped letters that six months ago I had an operation to remove the remains of a pregnancy, under general anaesthetic. When I handed the clipboard back to the beautician, she didn’t mention it. I wished that she would.
As I lay back and felt the hot ping of the laser dotting across my forehead, I thought how ridiculous this all was; that this laser-facial is something humans have figured out how to do. How has someone, somewhere, in a lab or the boardroom of a cosmetics conglomerate, conceived of this – a solution to a problem that barely exists – and yet no one can tell me why I can’t carry a baby?
There is no doctor who can reverse a miscarriage. Generally, according to medical literature, once one starts, it cannot be prevented. When I read these words for the first time, three years ago, after Googling “bleeding in early pregnancy”, a few days before what should have been our 12-week scan, I felt cheated. Cheated, because when you’re pregnant you are bombarded with instructions that are supposed to prevent this very thing. No soft cheese for you. No drinking, either. Don’t smoke, limit your caffeine intake, no cleaning out the cat’s litter tray. I had assumed, naively, that this meant we knew how to prevent miscarriage these days, that we understood why it happened and what caused it; that it could be avoided if you followed the rules.
You learn very quickly that the truth is more complicated. After a miscarriage, no medic asks you how much coffee you drank or if you accidentally ate any under-cooked meat. Instead you find that miscarriage is judged to be largely unavoidable. An estimated one in five pregnancies ends in miscarriage, with the majority occurring before the 12-week mark. Seventy-one per cent of people who lose a pregnancy aren’t given a reason, according to a 2019 survey by the baby charity Tommy’s. You are told – repeatedly – that it’s “just bad luck”, “just one of those things”, “just nature’s way”.
Just, just, just. A fatalistic shrug of a word. But this is not the whole story. “There is this myth out there that every miscarriage that occurs is because there’s some profound problem with the pregnancy, that there’s nothing that can be done,” says Arri Coomarasamy, a professor of gynaecology and reproductive medicine, and director of the UK’s National Centre for Miscarriage Research, which was set up by Tommy’s in 2016. “Science is trying to unpick that myth.”
Unfortunately, the roots of this myth run deep. It’s an idea reinforced by the social convention that you shouldn’t reveal a pregnancy until after 12 weeks, once the highest risk of miscarriage has passed. It goes unchallenged thanks to age-old squeamishness and shame around women’s bodies, and our collective ineloquence on matters of grief. The bloody, untimely end of a pregnancy sits at the centre of a perfect Venn diagram of things that make us uncomfortable: sex, death and periods.
An impression persists that, while unfortunate, miscarriages are soon forgotten once another baby arrives – that you’ll get there eventually. It’s true that the majority of people who have a miscarriage will go on to have a successful pregnancy when they next conceive (about 80%, one study carried out in the 1980s found). Even among couples who have had three miscarriages in a row, for more than half, the next pregnancy will be successful. Accordingly, the prevailing logic seems to be that not only is miscarriage something that cannot be fixed – it doesn’t need to be fixed. There is little research or funding for trials, and only glancing attention from the healthcare system. What is not being heard, in all this, is that miscarriage matters."
By: Megan Richardson, LMFT, NCC
"There is no doubt that COVID is putting a strain on a lot of aspects of our life, one of them being our relationships. While some couples may find that spending extra time with their spouse is creating additional problems in the relationship that once did not exist, many couples are also finding prior relationship concerns are now being placed into a spotlight that may have been easy to avoid or ignore before.I am a strong believer in the fact that the goal of relationships is surprisingly not to feel happy all the time, as it can be easy to blame unhappiness on a partner when there may be other contributing factors. Instead, it is important to acknowledge what you may be feeling in your relationship so that you can take action to address your emotional reactions.
Aside from being in a relationship where you or your children’s safety is at risk, unhappiness may not actually be a good reason to end a relationship. Our partners were not created to make us happy, just like we should not be expected to make our partners happy. Couples often find relief in learning most relationships go through seasons where they do not necessarily feel happy but can still have a satisfying experience in the long term if they remain committed and work on their relationship concerns. Happiness can be worked on. Couples who end relationships because they are unhappy often continue to find themselves unhappy outside of the relationship, as well.
So while it can be easy to blame your unhappiness on your partner, it may not be all of their fault.
If you find yourself feeling especially irritated with your spouse since the start of the quarantine, you are not alone. But it also may not be their fault."
By Meghan Holohan| April 20, 2020
"After experiencing infertility for almost four years, Sarah and Brian Piett felt thrilled to welcome their new son, Brooks, on February 26. Soon after, the COVID-19 pandemic dramatically changed life. Now friends and family can’t meet the baby or offer to babysit. As the quarantine lingers, Sarah feels more listless, worried and frustrated.
“Our whole family has really been waiting for Brooks forever and have been on this journey with us. We finally have our baby and nobody can even see him,” the 29-year-old recovery room nurse from Canonsburg, Pennsylvania, told TODAY Parents. “I’ve cried a lot.”
"After facing infertility for almost four years, the Pietts were excited to finally welcome a baby. But that feeling lessened as stay-at-home orders means Sarah feels isolated." -- Courtesy of the Piett family
"Sarah struggled to breastfeed and a phone call with the lactation consultant made her feel guilty about pumping and supplementing with formula. She wishes she had a little more help around the house or could even go to a moms group or walk around a mall.
“I love my baby and I love holding him,” she said. “Sometimes you wish that somebody was here just to hold him for like five minutes to give you a break.”
At her six-week follow up appointment, she scored high on a diagnostic test for postpartum depression. Her doctor gave her a prescription and a therapist recommendation. She feels like being isolated is making her depression and anxiety more severe.
“It sounds so selfish but I keep thinking this isn’t the maternity leave I envisioned. I thought I’d be able to see friends and they’d be able to see my baby and enjoy him,” Piett said. “It just totally all around completely sucks.”
Sixteen women on their personal transformations.
"I Started Saying Yes to No"
By Casey Wilson
"I am a yes person. Shonda Rhimes lived a “Year of Yes” and I have lived a lifetime of yes. In fact, I prided myself on coming from a place of yes, emotionally, whatever that means?
Yes, I'll take a red eye to be at your bachelorette party.
Yes, I'll help the male stripper round up his lose clothes after the music has stopped and everyone else stands around in horrified silence.
Yes, I'll co-lead a self-help retreat for friends in Joshua Tree, despite the fact my own life is in utter shambles.
Yes, I'll hurt when no one wants to attend!
Yes, I'll go to couples therapy with a boyfriend for a year after we stop dating to "tie up loose ends."
Yes, I'll suport your pyramid scheme and buy your chalky shakes and bad jewelry and Flat Earth pamphlets.
Yes, I'll sell those items myself, to little success.
Yes, I'll host. Yes, I'll speak. Yes, I'll march. Yes, I'll give. Yes, I'll be there. And here. And everywhere.
And perhaps most upsetting: Yes, I'll go to your one-person show.
And then I had children. Two spirited little boys. Suddenly I was barely getting to or even halfway doing the things I cared about most: working, deepening my marriage, tending to my precious female friendships, fighting for change and watching every episode of "The Real Housewives."
Something had to give, and it wasn't gonna be The Housewives. It became clear I had to drill down on what was truly necessary. That meant only doing the things it felt (as a friend puts it) "joyful for my spirit to do." I imposed a Marie Kondo-like approach to social commitments and anything that extended beyond the rewarding (yet relentless!) work of motherhood.
It's still hard for me to say no. It's simply not in my nature. I hate to disappoint people, be they a boss or a male stripper. But nothing forces you to create boundaries like having kids. We have only so much energy. I have, maybe, almost...none?
Because that sound we have always been aware of, that dim hum that has been running under our entire lives, grows louder as children are ushered in. It's the hum of mortality.
There's only so much time. We must say no in order to say yes to what is most essential.
Until the time comes to say goodbye."
"I Started to Worry About Failure"
By Nikole Hannah-Jones
"I grew up in a dysfunctional household because my father was an alcoholic, and when I was young, I would lie in my twin bed next to the window and write out the life I planned to lead when I grew up and gained control. I still have the battered, sunshine-colored notebook in which I plotted my future.
Our family was working class. We had no wealth and no family connections to open doors, but the one advantage I can claim was unwavering confidence in my ability to change my circumstance. I did not trust many people, but I trusted myself absolutely.
Even as a young child, I believed in my mind, my work ethic and my ambition. And so, my journal did not record my hopes for the future. It recorded what would be.
I have been afraid of many things in my life, but failure was not one of the. Until I had my daughter.
Because of my childhood, I have spent an inordinate amount of time thinking about all the things I would never do as a parent, all the ways I would be better. I had a determination to create the home life for my dhild that I wished I had growing up.
Yet before she breathed her first breath, when she was just a flutter in my stomach, I began to feel a tightness in my chest driven by a fear that I would not be up to the task. That no matter how much I loved her, I would make so many mistakes, mistakes I likely would not even know I was making, mistakes that would somehow scar my child the way that I feel scarred.I likely would not even know I was making mistakes that would somehow scar my child the way that I feel scarred. The confident control I have exercised over my entire life feels so tenuous now that I am in charge of raising another human being who is witnessing me and all my flaws while her personhood is being formed.
Even now as I now have more empathy for my own parents, I am consumed by the fear that in the most important venture in my life, I will fail. So when my daughter was just a baby, I started writing a journal to her. Over the pages, I tell her how much I love her, how much she means to me, how she has changed my life, and own up when I make mistakes.
My hope is that one day when she is grown up, this journal will allow her to extend me some grace for the failures I know I will make. It is a strange conversion. As a child, I did not find hope a useful thing. But now that I have my own, I often feel as if hope is all that I have."
By Alexander Sacks, MD + Catherine Birndorf, MD| May 9, 2019
Photo: Michelle Kondrich
"Thoughts like these are completely normal, but many new moms feel ashamed of having them. Here’s how to let go of self-judgment and too-high expectations, from reproductive psychiatrists Alexandra Sacks and Catherine Birndorf.
I’ve have been working in women’s mental health for the past decade and my mission has been to educate people about the identity shift that occurs with motherhood, a phase called “matrescence.” Like adolescence, this developmental transition is hormonal, physical and emotional — all at the same time. But unlike adolescence, this transition hasn’t been part of the public discourse, and new mothers often end up judging themselves for these natural feelings. Of course, this conversation also includes the transitions of fathers, partners, and non-birthing parents. To cover the experience of matrescence from pregnancy through motherhood, I coauthored (with reproductive psychiatrist Catherine Birndorf, MD) the new book What No One Tells You; below is an excerpt.
If you’re interested in learning more about the subject and hearing real women’s stories, I invite you to listen to my new podcast “Motherhood Sessions,” where I sit down with mothers and share therapeutic conversations about guilt, perfectionism and many other human struggles. My hope is that by reducing stigma and shame around these topics we can all start to better understand the mothers in our lives — whether it’s yourself or someone you know and love. —Alexandra Sacks, MD
We often hear moms whisper in hushed tones something they’d never tell their friends or partner: “Sometimes I wish I had my old life back.”
Or they wonder, “Am I a bad mother because sometimes I’d rather take a nap than nurse my baby?” These ambivalent thoughts are completely natural, yet many moms feel ashamed of them. We call this the push and pull of motherhood — sometimes you’ll feel pulled toward your baby’s needs and your identity as a mother, and sometimes you’ll want to push it all away.
Motherhood, like all complex experiences, is a mix of both positive and negative.
Loving your child doesn’t change the fact that sometimes the work of caretaking is not fun. Yet for many moms, admitting that there are moments, days or weeks when you want a break is scary, because it can make you ask yourself: “Am I trapped with this feeling forever? What if I made a mistake? Does this mean I don’t love my baby?”
Ambivalence comes up when you find your attention is pushed away from your baby to care for yourself and others in your life, and you don’t know how to make it all work.
With every choice, someone gets shortchanged. How are you not going to feel guilty about leaving a meeting at work to go to the pediatrician? Or sleeping an extra 15 minutes while your baby is fussing, only to find him lying in spit-up? And what about when you’re with the baby but really thinking about returning a friend’s call, replying to a work email, eating dinner with your partner, or sleeping?"
How to shift your mind-set from giving so much of yourself to others.
By Pooja Lakshmin| May 5, 2020
Photo: Dadu Shin
"I was teaching a group of new mothers a few years ago how to recognize postpartum depression and anxiety when a woman raised her hand. “My work is letting me take an extra two weeks of paid maternity leave. I don’t know what to do. I feel bad if I take it. My team will have to pick up the slack. I feel bad if I don’t. I’d be giving up precious time with my daughter.” I responded, “Is there any option you wouldn’t feel bad about taking?”
As a perinatal psychiatrist who takes care of women coping with the transition to motherhood, I meet mothers who lean into their guilt like it’s a security blanket and hold up their self-sacrifice as a badge of honor. Adopting a martyr identity doesn’t always correlate to clinical depression or anxiety. It’s a role that women can inhabit even without a diagnosable mental health condition.
I don’t blame those mothers for shielding themselves under a cloak of suffering. Appearing too well adjusted can be a liability. Leaving your kids in the car for three minutes to get a coffee can be grounds for a call to Child Protective Services and daring to bottle-feed your baby without trying to breastfeed can lead to criticism from strangers.
In 1996 Sharon Hays, Ph.D., a sociologist, coined the term “intensive mothering” to describe parenting that is “child-centered, expert-guided, emotionally absorbing, labor-intensive and financially expensive.” Two decades later, the mental load describes the invisible labor that goes into running a family. We still find ourselves living in a world where most mothers, even while working outside the home, bear the brunt of household work. The coronavirus pandemic only seems to be intensifying that pressure."