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Now What? Preparing for Birth After Infertility

By Ashley Brichter, Founder Birthsmarter

“Honestly, I just couldn’t believe that my body would make it to the finish line.”

Emmy is a 36-year old Professor living in Alabama, who got pregnant and gave birth to her son in early 2023 after three years of fertility treatments. She and so many others in our community were open to discussing their Post-IVF birth and postpartum journeys to shed light on this particular experience.

We think preparing for childbirth and postpartum life after fertility struggles deserves special attention. Not because your birth or postpartum journey is going to be physiologically different – once you’re pregnant, you’re pregnant – but because it’s enormously and uniquely challenging to cut through the noise of the “pregnancy advice industry” geared toward people who didn’t struggle to conceive.

Simple affirmations like “I trust my body” or off-handed comments such as “the baby will get out the same way the baby got in” just don’t ring true for everyone – and can be particularly biting for some.

You Do You: Preparing for Childbirth after Fertility Treatments

In the parents we interviewed, we heard equal justification for planned cesarean births, planned inductions, and planned home births. We heard justification for working with high-risk obstetricians and low-risk midwives. We heard justification for having doulas – and not having doulas. Despite the universal anxiety – the fear that something might go wrong – when it comes time to prepare for childbirth there are so many “right” choices. Even though you might have an overlapping experience with IVF, once you become pregnant there’s so much variation in personal circumstance when it comes to birth preferences.

It’s actually sort of beautiful to consider how many “right” choices exist, since it’s so common to feel a sense of failure during infertility.

As Emmy considered her birth plans, she saw the world pushing “vaginal birth as the only way.” That mindset is so counter productive to supporting families where a cesarean delivery or belly birth is the exact right choice. After three years of treatment and a prior loss, Emmy was over 35 when she got pregnant with her now son and was diagnosed with Gestational Diabetes. She planned a cesarean delivery and said, “honestly, I just didn’t trust my body. I couldn’t believe that my body could birth a baby.”

Sarah, on the other hand, was 30 years old when she started trying to conceive. As an otherwise “textbook” healthy and low-risk human, once she had a successful embryo transfer after 14 months of infertility she hired a home birth midwife and a doula. “I needed it to stop feeling so clinical,” she said.

Lauren, a first time mom in upstate New York, shared: “It was a struggle for me to decide where and how I wanted to give birth. My entire life, I grew up trusting doctors (I come from a family of wonderful, caring physicians). But my IVF journey left me with a distrust of doctors and a distrust of my body. I fell somewhere in the middle by the time I decided how/where to give birth: I learned to trust my body throughout the pregnancy, AND I found a team of OBs that I trusted and a hospital I felt safe in.”

Learning to Trust

Oxytocin, or the hormone that makes you coo at puppy videos, feel cozy when you get to cuddle with another human, and (hopefully) have nice strong orgasms is the hormone that’s responsible for uterine contractions in childbirth. When you’re in labor, oxytocin makes your uterus contract and contractions push your baby down and open your cervix up. Physiologically, being scared and releasing high levels of cortisol and adrenaline can prohibit the production of oxytocin. Evolutionarily, this is so smart! A human should definitely not give birth if they’re feeling scared. Not if there’s a predator nearby or a storm overhead. It wouldn’t be safe – for them – or their baby.

So, while hospitals have artificial oxytocin or Pitocin on hand, it’s reasonable to assume that learning to trust your body in pregnancy as a way of preparing for labor would be beneficial.

But, how can you learn to trust your body after infertility?

This seems to be an uphill battle for everyone. Paloma, a 41-year old first time mom in Brooklyn, NY described feeling completely demoralized. Emmy said she ”kept waiting for the other shoe to drop” even though her HCG levels kept doubling and things looked good. Lauren counted kicks every day and scheduled NSTs weekly towards the end of her pregnancy.

I don’t think there’s anything that can really make it less scary. Yearning for a baby is an indescribable feeling. And, it’s understandable if dreamy messages about the ease, joy, and magic of being pregnant and preparing for birth just don’t resonate. That said, there are sensitive resources – individuals and organizations – who can help you regain trust and develop confidence heading into birth and postpartum life while holding space for your fertility journey.

Emmy shared that though she couldn’t afford a doula, she wished she had someone to help her trust her body a little more. (For the record there are many creative ways to access sliding scale coverage or scholarships, find a doula who might barter, and/or find accessible birth education).

Lauren had the ability to take “an inclusive and thoughtful birth course”, and did a lot of physical work with a prenatal coach. She shared that “Birthsmarter prepared me mentally (and logistically) on what to expect, and Joanie helped me use my physicality and workouts to know how to breathe through contractions. Looking back on my labor, I feel that these two women truly prepared me as best as possible for something I had never done before. Also, I had read so much about how women's birth preferences got completely turned upside down during the birthing process (I read Transformed By Birth and it was the best book I read during my pregnancy) so I just focused on being open to change throughout the birth. This really helped me during my 30 hour delivery that, of course, did not go as planned!”

“I don’t think I started to think about the birth until 32 weeks.” - Emmy

Preparing for the Unknown

Of course, preparing for actually giving birth is going to depend on a lot of factors. And whether or not someone has struggled with infertility or loss, there’s no way to predict how a labor and delivery experience will unfold. Across the board, though, we heard that after infertility, folks had really low expectations for their births.

Paloma, was pleasantly surprised though, “Honestly I had fun. It’s a highlight of my life, by far.”

As a birth educator, I’m obviously biased when it comes to the importance of childbirth education in birth preparation – however, not all childbirth education or birth planning is created equal. Childbirth education for folks who’ve made it through fertility treatments needs to strike a fine balance between “here’s what you need to know and how you can help the process go well AND here’s how you're totally out of control and how to prepare yourself to cope with plans B, C, D, and E.”

Even though Paloma, Emmy, and Lauren all communicated different versions of “I just wanted to survive and I just wanted the baby to survive”… no matter what your starting place, two things are true: one, your birth story matters. Two, you have more control than you think.

How you welcome your baby into the world – meaning how you’re treated throughout the process and therefore the story you tell yourself about your body, your ability to care for your baby, and your position within institutional power dynamics – is woven into the fiber of your identity for the rest of your life. It’s easy to feel powerless going into something so big and unpredictable. And it’s true that no birth class, doula, or midwife can guarantee a short, easy, vaginal birth but the work we do to prepare for labor can help us heal past wounds and in the process, move forward as more complete versions of ourselves.

The most important decision any pregnant person can make is where and with whom you plan to deliver. If you’re low-risk, you’ll want to work with a provider who specializes in low-risk birth. Midwifery care, by nature of the discipline, is going to offer low-risk clients the most hands-on, patient-centered care which will be essential to regaining trust in your body before birth. Working with a hospital based midwifery practice often offers expectant parents the best of both worlds when they want access to all potential medical interventions with the least intrusive and fear-mongering attitude. If you’re high-risk there are wonderful Maternal Fetal Medicine specialists (OBGYNs with three additional years of training in pathology) typically have a much better handle on providing medical care without causing unnecessary worry than traditional obstetricians.

From there, it’s important to entertain all the options for the specifics of labor and delivery. If you’re trying for an unmedicated birth you might end up with an induction, and epidural, or a cesarean birth. If you’re trying for a medicated birth, labor might start fast and end quickly. Even though there’s no way to predict, understanding birth physiology, how to navigate the medical system, and how to keep an open mind are all critical skills for birth preparation and postpartum recovery.

At Birthsmarter, we know there is not one right way to give birth. We specialize in teaching unbiased and inclusive classes for all types of birth, including planned cesarean births that strike a balance between teaching you to trust the process and realistically prepare for all the options.

Postpartum Planning after Infertility

Once you survive the birth, the question really is: what comes next?

And all we can say is: prepare for a bumpy ride. Having a baby even in the best of circumstances is HARD. Healing from birth, even in the best of circumstances is HARD. The reality for folks who move through fertility treatments is that you’ve been on a JOURNEY. And, you’ve likely not taken anytime to really process or heal from the trauma or challenges you’ve endured. You roll from there into a heightened-anxiety state during pregnancy and then BOOM your life changes forever because now you have a baby-in-arms.

On one hand, you might think you should be happier than you’ve ever been before. You worked so hard for this! And on the other hand, your past desire and effort do not make postpartum life any easier… and as you feel exhausted, depleted, and overwhelmed you might find yourself questioning your decisions. And then, feeling guilty.

As Emmy said: “We spent so much time getting pregnant… and now I feel guilty all the time! I wish someone who had been through the same thing I had gone through had told me that it’s going to be hard. It’s ok to be tired and question your decisions. That you don’t have to have this toxic positivity (which I had during my pregnancy)… It would be nice to hear this from someone who’s been through infertility!” - Emmy

Very few people who are pregnant prepare for postpartum life. It’s so much more exciting to prepare for labor and delivery and infant care. But, at some point, and with a huge amount of sensitivity, it’s important to consider how to set yourself up for success postpartum. Paloma said: “I wish I engaged with the reality of post-birth, latching, cluster feeding, physical healing… I was completely ignorant and I regret it because I didn’t prepare myself with the knowledge I needed, especially around breastfeeding.”

I wish there was a magic switch. A pill to take that would help take away the pain, disappointment, and guilt. A pill to take that would allow you to feel strong, powerful, and ready to head into birth preparation and labor and delivery with confidence. But, like so much, else it’s going to take time.

Right now, we want you to know that this feels complicated because it is. That you’re not alone. And that there are thoughtful resources out there who can hold space, educate, and support you in a way that speaks to your fears and concerns and can hopefully help dial down the worry without drowning you in toxic positivity.

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