When you’re having trouble getting pregnant, becoming pregnant is just about all you can think about. The goal is to see that double line on the test. Each month is the same—starting a new cycle feeling hopeful only to see hope morph into discouragement and eventually grief and sadness. You begin to resent hope but can’t stop yourself. All while watching what seems like every belly around you swell with joyful bundles.
And then it happens. You are finally pregnant! After months and years of sorrow you can now relax into the relief of knowing it’s your turn. Except, you’re not relieved, you’re…anxious as ever!
While frustrating, this is a common emotional reaction after infertility. Patients who have gone through infertility and pregnancy loss will commonly be surprised to feel more anxious once they’re pregnant than ever before in their fertility journey. They deserve the relief they were hoping for and should be able to settle into the joy they’ve worked so hard for. But unfortunately, that’s not how our brains are designed.
Remember the saying “practice makes perfect?” Each time we learn something new and do it over and over our brains engage in what is called neuroplasticity. This means that when we learn something our brains make a connection from one neuron to another. And each time we do it again, that connection strengthens.
When something has a lot of emotion attached to it, that process gets sped up or intensifies. For example, if you burn yourself on the stove, it hurts and so that neural connection (if I touch the stove, I get hurt) is strengthened as a means to protect you from touching the hot stove and hurting yourself again. A similar process happens with infertility and pregnancy loss. The more cycles that go by without getting pregnant or experiencing a loss, the stronger the connection between trying for pregnancy and heartache.
When clients find themselves pregnant, we talk about the typical peaks and valleys of anxiety that follow:
The first few weeks: There is a lot of uncertainty and the only blueprint clients are working from is one that leads to grief. Those neural connections tend to “trick” clients into thinking that they know something bad is going to happen. And why wouldn’t they? Every time they saw a negative pregnancy test, held their breath to wipe in the bathroom, picked up the phone to talk to their reproductive endocrinologist about test results—they were typically getting bad news, therein strengthening that connection that ‘trying to be pregnant equals heartache.’
After the first appointments: If these went well then clients get brief periods of relief. They’ve gotten the reassurance they needed that the pregnancy is intact and progressing. This usually lasts a few days to two weeks. Anxiety remains high in between appointments but typically not at the intensity it was in the beginning.
Special note on pregnancy loss: For clients with a history of losses, it’s normal for anxiety to remain steadily high until they pass the week they lost their longest pregnancy. And while the intensity of their anxiety may be higher in comparison to someone without a history of loss, they will still see some degree of anxiety reduction with time. This is also when clients may grapple with renewed grief from a previous loss, guilt over being excited for this pregnancy and so many more complicated, yet completely human responses to trauma.
Before every appointment: The day or two prior to a checkup clients notice bumps in their anxiety—more worry, distraction, fear that they’re going to get bad news. Then comes the period of relief afterwards.
Once movement can be felt: This is when clients see a drop in anxiety levels. Daily, if not hourly reassurance through baby’s movement brings the comfort they’ve been hoping for.
So you’re newly pregnant, feeling anxious but hopefully have a better understanding of why you’re anxious and how this anxiety will play out. But you’re likely wondering how to actually cope with that anxiety, especially during its peaks. Here are some places to start:
• Use your breath. When your body is revved up with anxiety, it’s sending signals to your brain that something is wrong and you should worry/do something to stay safe. But, you’re not actually in danger. Taking slow, deep breaths will slow all of those physical systems down, giving your brain a little more space for rational thinking.
• Use your support system. Talk with your partner, friends or family who “get it.” These are people who won’t placate you with toxic positivity or invalidate your feelings. Using your support system can be a heart to heart or it can be texting a friend to send you a funny Tik Tok to help get you out of your head.
• Engage in self care. This is the time for self care both big and small. Go for the hike, buy the flowers, light the candle. Will they take away your anxiety? Absolutely not. But you’re going through something tough and deserve to nurture yourself through it. •
• Make plans. Waiting for your next appointment can feel like an eternity. Schedule activities to look forward to that help break it up. •
• Ask for help. OBGYNs and Midwives are very accommodating when it comes to reassurance checks. You can schedule them or ask to be squeezed in and get a doppler check. Find a therapist that specializes in reproductive/perinatal mental health. Telehealth opens statewide options for you to see someone who focuses on this area of mental health. Connect with a perinatal psychiatrist to discuss medication options. There are medications that are safe to use during pregnancy to help manage what feels unmanageable.
Like most things in life, pregnancy after infertility and loss brings about a lot of conflicting emotions. And as with many of life’s challenges, gaining support, asking for help, and a whole lot of self compassion can help get you to the other side. If this is your journey, I wish you the absolute best in this next chapter.
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