Not Having Children After Infertility ‘An Assault to Identity’

Women who experience infertility and do not gone on to parent get short shrift not only in society but in research. They are left to cope without much needed support or understanding. This is made all the more difficult amid the deification of mothers.

That’s why I’m pleased today to share an online discussion with the author of a dissertation that breaks ground and shines the spotlight on a community of women who for too long have been overlooked. The newly published research, Recovery from Traumatic Loss: A Study of Women Living Without Children After Infertility, comes from the University of Pennsylvania. You might remember the call for participants came in a post here a year ago.

Dr. Marni Rosner is a New York City-based licensed psychotherapist. Her specialties include working with anxiety, relationship issues, trauma, loss, and infertility. She can be reached at marni.rosner@gmail.com. She shares more about her research here on the Silent Sorority blog and welcomes your comments.

What led you to this topic?
I had been ambivalent about having children, yet found myself surprisingly overwhelmed when I discovered I wasn’t able to. And, despite all my education, and years of clinical experience working with clients with varying degrees of anxiety, depression, and trauma, I had no knowledge of the psychological trauma of infertility! I didn’t understand my reaction, nor did anyone else in my support system, including colleagues.

And you, Pamela, unfortunately, were not yet on-line. The isolation was incredible. So I began reading, which has always been a safe harbor for me – you know, knowledge is power and all that.Yet, I was unable to find research that addressed infertility for those who were not interested in adopting or third-party reproduction. There was Sweet Grapes, of course, now a classic, but no real research. I also attended numerous conferences and workshops on infertility; all focused on increasing one’s fertility, IVF, donor eggs, and adopting. It seemed, and felt, that deciding to not have children after infertility was as isolating as living on Mars!

How did it go over with your advisors?
They were all wonderfully supportive. The primary concern, always, is, “is this research necessary? Has it been done before? If not, why? Will it really enrich our knowledge base?” One professor said, early on, “It must be interesting to more than just your own mother!” So this certainly passed the ‘sniff’ test. There was really no other research that focused solely on this population in this era (with numerous reproductive options available, and so many life choices available for women).

What about your peers in the program? How did they respond to your topic?
Everyone seemed receptive and interested. I sometimes wondered if I was making some of the 30-somethings in the room, who didn’t have kids, anxious, although no one ever said so. An interesting moment occurred during my proposal defense – which is when I formally presented why this research is necessary. There were probably about 10 people in the room – my three advisors, some classmates, and a few others. During the Q and A, someone began a question, “for women who decide not to have a family…”. Three people in the room, at the same time, immediately jumped all over this, responding, “They have families, they just don’t have children!” That was interesting for me, especially since I hadn’t caught the slip. So to immediately have that effect – that I was able to communicate the significance of this topic to the point where language immediately became sensitive – was rewarding.

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What were some of your biggest takeaways or surprises in researching previous studies associated with infertility?
It was shocking to me how little attention was given to the aftermath of infertility. As of 2007, only 2% of the research explored the post-treatment phase of the infertility experience. Infertility is traumatizing! Even if you eventually have a child, through biology, adoption, or third-party reproduction, it changes you. A few years ago, I went to a talk, for clinicians, given by a woman who was interviewing (and filming) women who had adopted after infertility, and encouraging them to reflect on their infertility experience.

The filmmaker showed a clip of a woman who just cried and cried remembering that time. The interviewee had clearly buried these emotions for so long, and had never worked through the trauma and loss of her own experience from many years before. It may not all go away just because you have a child – a lot also depends on your history, what came prior to the infertility. Anyway, after the clip, we clinicians began talking, and the discussion immediately focused on adoption! I observed what was happening and redirected, but it was tough to stay on topic. I think it can be frightening to sit with intense emotions.

Many people view infertility as a deeply private, personal experience, however, you make clear that recovering from infertility is actually more of a team sport – meaning we can be seriously helped or hurt depending on the actions/behavior of those around us. Can you elaborate further?
I think much of the reason infertility is viewed as deeply private and personal is because it is often experienced as extremely shaming, and it’s instinctive to keep our shame close. This is compounded for those who were raised in an environment of shame, secrets, and/or unresolved childhood trauma. When we do reach out for help, we are often rebuffed – often not intentionally – and it’s hard to not be sensitive. So we wind up with unacknowledged and disenfranchised grief, feeling stigmatized, our relationships with friends and family suffer, and basically experience an assault to our identity. It becomes self-protective to not talk about it. But this doesn’t really work; it simply lessens us. We need to give voice to what has happened in order to move the trauma through our bodies and minds and make sense of what has happened.

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This isn’t new – Shakespeare talked about the power of giving voice to sorrow, Freud addressed the “talking cure”, and the Catholic Church embraces this concept in the form of confession. 12-step programs, such as Alcoholics Anonymous, adopt this method as well. Give voice to your struggle, and something shifts internally. Having a witness to your process is quite powerful, and more witnesses are even better. What I found, in the study, was that this process was circular, reinforcing, and progressive –shame began to decrease as the women found a safe place, or places, to talk about what had happened.

As shame decreased, voices became clearer, and the women were more able to integrate, rather than disavow, the loss into their life story. This made them stronger and more confident. Shame holds us back, diminishes, and slowly destroys us. So – yes – it is a team sport. It takes a village to not have a child! Unfortunately, for women who decide to live without children after infertility, there is no obvious place to go for comfort. You have to work at it by either educating your current supports, or finding new ones. It isn’t easy, and requires energy that has often been depleted due to trauma. That’s why sites such as yours, and Lisa’s, among others, are so critical. They are, literally, life-saving.

You cite numerous theories and studies associated with human development and personal growth (for instance, you describe the concept of “twinship” — seeking to avoid feeling alone in the world — as well as a need for an “accepting, confirming and understanding human echo”) … what’s the impact when these are denied?
The “accepting, confirming and understanding human echo” – isn’t that lovely? That’s Heinz Kohut. Kohut addressed the different relationships we need, throughout our lives, to feel stable and well. One of these is a “twinship” relationship, which provides the feeling that there are others like me in the world, someone who understands me. When this doesn’t exist, or disappears, it can result in feelings of utter aloneness, deficiency, maybe some regression. It can be pretty unsettling and scary.

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Many theorists from various schools of thought believe that our relationships have a direct impact both on identity and ongoing development. Certain theorists believe that this is particularly true for women – that disruptions to certain relationships are experienced not only as a loss of a relationship but something closer to a loss of self. Women who experience infertility often face disruptions to their relationships, and for those who decide to not have children after trying, this issue, this assault to identity, may not resolve on its own. There needs to be some active work around it.

It’s reassuring that you’ve gathered evidence to prove what many of us living without children after infertility already sensed keenly – that we’re living in an extended pro-natal period. What implications does this have for those who don’t fit the pro-natal norm?
This is a great question. I really don’t know. I think, at this time, you, Lisa, and all the other bloggers and voices addressing this issue are in the process of forming what this means. We are what I would call “in the process” of developing the narrative for those living outside the pro-natal norm. We have the power to direct this a little, I think. Don’t forget those who have chosen to be childfree, despite all the cultural and societal messages to have children. They are a great crowd – they can be so normalizing! And – just a quick statistic – the number of women, aged 40-44, without children has doubled to 20% since 1976 – this includes the voluntary childfree. That’s an enormous change in a relatively short time. So, again, we are in this moment contributing to and shaping the dialogue.

Based on your research/findings, is there anything you’d like to add – words of advice – for the “silent sorority?”
You know, there was such fantastic advice, words of wisdom, and relevant stories told by study participants, that I could not possibly do them justice here. I would encourage those interested to read the paper. It’s long, but I think it’s pretty reader friendly. Maybe focus on chapters IV and V (the less theoretical chapters) to best hear the actual voices and themes. And, of course, I’d love to hear any feedback and questions!
Readers: Get your highlighters out. You can find the full dissertation, RECOVERY FROM TRAUMATIC LOSS: A STUDY OF WOMEN LIVING WITHOUT CHILDREN AFTER INFERTILITY here at UPenn. The discussion is officially open.