Category: articles and other writing

Opportunity Lost

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October 15th is the International Day of Pregnancy and Infant Loss Remembrance. In honour of all the mums and dads out there with heavy hearts tomorrow and every day, I am publishing two pieces, written a while ago now, but always relevant.

They’re neither short reads nor easy reads. I wrote them with loved ones in mind.

Opportunity Lost: Men’s experience of miscarriage and loss

By Shannon Meyerkort

‘As soon as you see that little line on the pregnancy test, you already have hopes and expectations and are planning for the future… but a miscarriage? It’s almost like an opportunity lost.  Especially from a man’s perspective – you see that vision of the future disappearing and there is nothing you can do about it.’

Over the course of 2010, Seb’s* wife was pregnant with three different babies and she miscarried all three. This story however, is not just about her. Fathers are often the invisible party in the pregnancy process.  Flick through the pages of one of the many glossy pregnancy and parenting magazines available, and the absence of men is striking.  After all, it takes two to make a baby. Despite this, men’s role in baby-making after their initial contribution has traditionally been very restricted, and despite changing expectations in today’s society, their involvement is often still limited.

CHANGING EXPECTATIONS

‘Historically, reproduction has been within the domain of women,’ explains Belinda Jennings, a Clinical Midwife Consultant at Perth’s King Edward Memorial Hospital. ‘Midwife means “with women”, so it’s always been that birthing is women’s business.’ Yet this is changing, especially in high-income countries such as Australia, says Jennings. As the gap between men and women is closing with regard to work/life balance and parenting, we are finding that their roles are becoming more integrated.

As a result of this shift, there is now a new wave of emotional men who are more involved – or expected to be involved – with their children. ‘Men have become more emotionally mature,’ says Jennings.  ‘It’s only one generation ago that whole platoons of men were being wiped out in a war, and they had a very different approach [to parenting].  A lot has been happening on the men’s front in the last 50 years.’

The constrained version of masculinity that we are familiar with today arose out of the colonial expansion in Britain and the US, explains David Buchbinder, Professor of Masculinity Studies at Curtin University. ‘Emotional impassivity became a way of dominating and controlling, whether the family or business’. Buchbinder believes this stoicism still influences many men of the current generation, predominantly through their fathers and grandfathers and how they have been raised.

Belinda Jennings agrees, and believes that the clash between these older style ideals – and the new expectations of their wives and partners – is why the current generation of fathers struggle with how to react to grief and loss. ‘The protector – the strong, stoic man – is not the predominant expectation in our culture anymore, and I think that’s where they get confused.  There is this expectation from the generation prior that they would be strong and silent, yet I think modern society is expecting the new age, sensitive guy to be emotively overt.’

THE DADS’ STORIES

Seb and his wife Jess*, both 37, never intended on only having one child.  But after a relatively tough pregnancy and first year with Josh*, now four, they decided to wait at least two years before trying again for another child. Jess quickly fell pregnant, but by about six weeks she had realised something was wrong and she lost the baby shortly after. ‘After the third miscarriage, it was a sign to start going down the IVF path’, Seb admits.

Each miscarriage presented its own difficulties, physically and emotionally for both Seb and his wife.  Physically Jess had the worst of it. She had a chemically induced termination where prostaglandin is used to make the uterus contract and expel the fetus; a D&C (dilatation and curettage), a surgical procedure where the fetus is removed under anaesthetic; and a ‘natural’ miscarriage, where the body naturally expels the fetus.  None were easy.

There was little Seb could do to help. ‘There was nothing I could do at home’, says Seb. ‘It’s one of those things that you feel a bit on the outside, you don’t get to experience the highs and lows of it, but you have to be as sympathetic as possible.  But unless the experience is happening to you, you can’t ever put your feet in that person’s shoes’.

Peter (34) agrees with this sentiment. His second child was diagnosed with anencephaly at 13 weeks gestation. This is a congenital condition involving malformation or absence of the brain.  Although they could have continued with the pregnancy, the prognosis for the child was early death, even if it were born alive.  Peter and his wife Abbie, 35, made the difficult decision to terminate the pregnancy.

Like Seb, Peter often felt secondary to the process. ‘I can understand that a man wouldn’t have the physical connection’, says Peter. ‘I think a lot of people just think that guys will just soldier on,’ Peter says. ‘But this day and age I think we’ve changed… and I do think men get a bit gypped.  Not during the process because we have to take care of the person who is holding the baby physically, but afterwards – psychologically…’

TAKING SECOND PLACE

Both men agree that the focus is – and should be – on the woman, but it is short-sighted not to see that the husband can also be badly affected. ‘You learn that the IVF process is not about the guy and nor should it be,’ says Seb. ‘But you feel extra to the process, effectively removed from any involvement in the pregnancy.  I did everything I could to support Jess but you very much get pushed back a lot of the time.’

The helplessness men experience in these situations is understandable.  Once a miscarriage has started, there is nothing that can be done to prevent it.  Medical intervention might hasten or modify the process, but the end result is inevitable. And while the physical burden of the miscarriage must be borne by the woman, the man is left with little to do. ‘I’m always trying to solve problems,’ Seb explains. ‘It’s a standard male thing.  I think “what can I do to make this right and how can I fix it?” But this is something you can’t fix.  You feel pretty helpless.’

This desire to fix things and ‘do’ things is a common reaction for men following the death of a loved one, writes Ben Golden, a psychotherapist and author on men’s grief. In times past, men would have been responsible for building the coffin or digging the grave, but with  modern funerals left to ‘death professionals’, this leaves men with nothing to do following a death.

Peter agrees that he found the process of losing his baby difficult. The unfamiliar path of losing a child meant that he felt lost and unsure of what to do next. ‘When my Dad died, I was the one who just got on with it, made sure everything was done right, and then I could grieve.  But this time, even from the start, I didn’t know what to do.’

I DON’T WANT TO TALK ABOUT IT

There are many services available to help grieving parents. ‘The social worker gave us numbers of people in our area if we wanted to talk, and there was a support group for it [anencephaly]’, Peter recalls.  Ultimately however, he decided not to seek out any formal counselling or support services.  Instead he found that friends and family readily approached him offering support and their own stories. ‘The amount of work people who have come up to me and said “we lost our first”. It did help.’ Peter and his wife were quite open about their loss, regularly sending updates to close friends and family members about what ended up being a week-long journey from diagnosis to termination.

This contrasts with Seb and Jess’ decision to keep their miscarriages incredibly private.  Even their parents do not know the full extent of their loss. ‘I found it hard, not talking about it,’ Seb admits, ‘because it’s a pretty emotional thing to go through. Even from a male’s perspective, I’m a terrible communicator at the best of times so I didn’t speak about it. But it’s something you spend a lot of time thinking about in the background, thinking about what could have been.’

Seb did not even talk much about the miscarriages with his wife, preferring to focus on physical healing. ‘We didn’t really talk too much,’ he recalls, ‘we focussed a lot more on Jess getting better because it was quite a painful and unenjoyable experience to go through.’

There were many reasons why Seb did not speak more about his experience.  He is the first to admit he is a very private person and not comfortable with speaking publicly about emotive topics.  He was raised by parents who, while loving, are not overly demonstrative or emotionally open. He also lacks a close male friend with whom he could comfortably share his sad news. ‘We chose not to tell people,’ Seb explains.  ‘It’s a taboo subject.’

Ultimately it was an almost random encounter at work that provided the one opportunity for Seb to talk with another man about his experience.  A generic question about children led to the discussion of age gaps between offspring. Seb then frankly admitted that Jess had experienced multiple miscarriages.  The other man was quick to admit that his wife had just experienced her first miscarriage. ‘I found it – not quite liberating,’ says Seb, ‘but a weight off my chest.  A problem shared is a problem halved.’

Sharing his pain was a healing experience for Seb, and the other man obviously felt the same. Some weeks later he sent Seb an email which concluded ‘whilst from a business and networking point of view it was really great to meet you, I really personally appreciated you being so open with me and sharing your personal experiences that will really help me and my wife.’

Although neither Seb nor Peter sought any formal support, there are a number of services available to those in need of professional counselling.  Many of these services are free and anonymous such as MensLine Australia, one of the many offered by Crisis Support Services.  According to Ann Beck, the Relationship Manager of Men’s Services, between July 2010 and June 2011, MensLine received over 230 calls from men seeking assistance following the loss of a child. Perhaps tellingly, the vast majority of calls were from men needing guidance on how to support their partners through a difficult time. Less than 10% of calls were from men seeking personal counselling for themselves following a miscarriage or death of a child.

BEING A ROCK

Men are frequently expected to be strong in these situations, as Elizabeth Levang, a human development psychologist in the field of grief and loss explains, men are supposed to be a rock. There is a widespread expectation that they will manage their partner’s grief, protect their family from further harm and fix what has happened. Perth obstetrician Dr Melissa O’Neill agrees that this is frequently what happens in the event of a miscarriage or stillbirth.  In her office, when delivering sad news to expectant families she finds ‘dads are forced into a role, and that is to be very supportive of their partner. Their job is to say “it’s ok”.  They’re sad but it’s not the right situation for them to give into their grief. Maybe because I’m a woman they feel they have not got permission to fall apart, but dads are very stoic and that’s it.’

However, this self-control may be out-dated says Belinda Jennings. ‘I think that’s one of the things that has changed in the last generation or so.  I’m not saying men were less sad 30 or 40 years ago, I just think they didn’t have the permission to show their emotions.’  Today’s dads not only have permission, they are expected to be able to express how they are feeling.

David Buchbinder agrees.  ‘Whether men are able to express grief openly would depend, I believe, in the first instance on generational and class differences.  Younger males, particularly of an educated middle class, have learned to allow their feelings, including grief, more public exposure than their fathers or grandfathers might have.’ Similarly, one of the major shifts in masculinity in the closing decades of the twentieth century, explains Buchbinder, was the greater involvement of men in parenting, and as a result, a greater expression of emotion and attachment towards children.

THE DECLINING BIRTH (AND DEATH) RATE

Belinda Jennings explains that these significant behavioural transformations have been occurring at the same time as a steadily declining rate of infant mortality. In the past, pregnancy loss was a very common event with up to one in every two pregnancies lost before birth, and one in three children dying before the age of one.  Today however, with declining fertility, pregnancy itself is a much less common event, making pregnancy loss even scarcer. In fact, as the Australian Institute of Family Studies report, the fertility rate in Australia has been at a historical low over the past decade, with the average woman giving birth to only 1.9 children in 2009, compared to 3.5 in 1980.  Yet while there have been enormous developments in medical care which prevents much infant mortality, that same medical prowess also means that we are more aware of pregnancies and what can go wrong.  Despite the fact that miscarriage may be less common than a century ago, the ABS estimates that 30% of all conceptions end in miscarriage, meaning that of the 500,000 conceptions in 1997, 150,000 of them ended in miscarriage, and another 2,000 in stillbirth.

MEN CRY TOO

Guilt is not just a female emotion. When men are unable fix things, the guilt they experience can be overwhelming. At the same time if they don’t express sufficient emotion they can be made to feel guilty about being heartless. Peter explains ‘I sometimes feel guilty that I don’t think about it more.  I don’t know whether I should sit down and dwell on it, or is it enough that I just think about it quickly and then get on with it?’

There is no prescription for how a man should respond to the loss of a child. There is no prescribed period for mourning a lost opportunity. What Peter did not realise though, was that he was mourning his child every day. ‘We are planning on buying a lemon tree, to remind us of the baby.  I have – in the shower – a lemon body wash, but there was only a little bit left in the container and I haven’t touched it since. I don’t know why, it’s one of those things, but I think about the baby when I look at the lemon body wash in the shower.’

STAYING TOGETHER

Belinda Jennings believes there is no evidence to suggest that the relationships of couples experiencing grief break down any more often than ordinary couples. Perhaps some of that has to do with the couple-based therapy offered by a range of services including King Edward Memorial Hospital. ‘I think my one piece of advice would be to stay on the same path,’ says Jennings.  This means you can walk alongside each other, without having to share the same footsteps, says Jennings, so despite the different involvement of men and women, their overall experience is shared.

Sharing is perhaps the closest thing to a solution the dads can offer. Seb admits in the course of the interview he has spoken more about miscarriage than he has to Jess. ‘But the thing is it’s not discussed, it’s not talked about, it’s not shared,’ Seb says. ‘It’s not something to be celebrated but I guess it’s a fact of life for a lot of people.’

These stories are as profound as they are commonplace.  Miscarriage and pregnancy loss does not affect just the mother, and there will always be more than one side to each story. There may be no shortcut out of the grief, but by allowing these stories to be shared, we acknowledge men’s experience and role in the process. And this is one opportunity we should not miss.

*names have been changed

FURTHER READING

  • Swallowed by a Snake: The Gift of the Masculine Side of Healing by Ben Golden (Golden Healing Publishing, $13.95)
  • Manhood by Steve Biddulph (Random House, $14.95)
  • When Men Grieve: Why Men Grieve Differently and How You Can Help by Elizabeth Levang (Fairview Press, $14.95)

USEFUL CONTACTS

  •  Mensline.org.au 1300 789 978 A national telephone support, information and referral service for men with family and relationship concerns

Keeping Mum

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October 15th is the International Day of Pregnancy and Infant Loss Remembrance. In honour of all the mums and dads out there with heavy hearts tomorrow and every day, I am publishing two pieces, written a while ago, but always relevant.

They’re neither short reads nor easy reads. I wrote them with loved ones in mind.

Keeping Mum

By Shannon Meyerkort

Keeping mum ˃ adjective, informal, concealing a secret; saying nothing

It’s the opposite of childbirth. The antithesis of joy. It is the absence of friends and family. It is packing away the never-worn baby clothes.  It’s the mental readjustment of what is going to be, into what could have been.

Instead, it’s the silence, the stillness that comes with the loss of a baby. The unspoken congratulations. The ungiven gifts. The empty photo albums. Miscarriage, abortion, still birth: the taboos around them are like invisible walls, trapping parents-not-to-be inside.  Often we do not know how to speak of this pain, so grieving parents often suffer alone and in silence.

Yet miscarriage is surprisingly common.  Statistics vary, but it is agreed that at least 20 per cent of all pregnancies end in a miscarriage.  The older the mother, the higher that number creeps.  For women over the age of 40, data suggest that one in two pregnancies will end in miscarriage.

Despite how common it is, when is the last time you heard people talking about it. Just when is the right time to tell friends, content with their own new babies, you have miscarried for the third time in a year?  How do you tell family that the baby growing inside you is at high risk of massive genetic abnormalities and you might choose to abort rather than bring a sick child into the world? How do you face the faces of judgement?

I have been one of the lucky ones.  Three straight forward pregnancies.  Three beautiful daughters.  I had heard sad stories about colleagues and friends of friends  – sometimes the tales would border on urban myth.  But these were people far removed from me; I had never looked a woman in the eye who had just lost a baby.

A conversation with a close friend about her fear and distress upon being told her 11 week old unborn baby might have genetic abnormalities was the first time I came close to this agonizing topic.  For two weeks, she had kept the terrifying news to herself as she faced a battery of invasive and painful tests.  She disconnected not only from the baby she might lose, but from her network of friends and family.  She could not bear people knowing she might need to choose to abort the baby.  So she told no one. She was completely alone at a time when she needed the most support.

It was a sad moment when I realised that my friend felt she could not share her grief for fear of being judged by those closest to her. Did she feel she did not have permission to burden others with her sorrow? But spend five minutes with almost any woman, chances are she has a story about a baby, a miscarriage, a lost dream.  Some stories happened long ago, some are still taking place.

Then unexpectedly, I received a message via Facebook.  Another close friend who was 12 weeks pregnant had been to her first scan.  The baby had anencephaly.  The baby’s brain had formed outside its skull, and there was nothing that could be done. My friend would need to undergo a termination.  Just two days before we had all sat around the kitchen table, sharing brunch and happy stories about our children. There had been no shadow that day.

I deliberated for what felt like ages in front of the keyboard.  I didn’t know how to respond.  She had just been given the worst possible news, and the following week would be one of anxiety, uncertainty and the ultimate grief.  How do you respond to news like that via Facebook?  If she had been in front of me I would have hugged her.  If she had been on the phone I would have cried and asked her if she wanted me to come round.

But now I was unsure what was expected of me.  How do I know when she is ready to talk?  Do I send flowers?  A card?  How do I not be the well-meaning but insensitive person who inadvertently makes thoughtless remarks at a time she is at her most sensitive?

Of course, it wasn’t just me who was struggling with what to say.  The people experiencing this loss often don’t know when or how to tell their stories.

‘I kept my miscarriages quiet from my family,’ Julie told me from across my kitchen table. ‘My family, who I’m very close to.  It’s like you are protecting your choices and your emotions.’  Julie was pregnant for nine months that year.  Three different babies, each ending in a miscarriage.

‘I was doing all this without my family knowing, so I didn’t have anyone to call on.  You don’t want to share it. This is my thing, and I didn’t want to be dealing with their emotions as well.’

It was a quiet Sunday morning.  Still and silent except for the intermittent calls from the flocks of cockatoos and magpies inhabiting nearby parks. On the kitchen table, plates of untouched caramel slice reminded us of our weight loss goals.  Julie and I had known each other for years, having met through a Mothers’ group when our eldest children were barely six weeks old.  In the years since, seven of the nine Mums in our group had gone on to have a second baby, and she had experienced three miscarriages.  I had vaguely known that she had one miscarriage, but it wasn’t something we had really discussed. ‘I didn’t keep it from you, but I wasn’t going to offer,’ she admitted.

I wondered whether we had all been too self-involved to notice that she was struggling, and Julie responded by asking when the right time would have been for her to mention her miscarriages – at the Christmas Party we held each year?  At baby showers? ‘I didn’t want to rain on your parades when you were pregnant.  You needed to be excited, I certainly would be if I were pregnant.’   So she remained quiet, and battled through her grief alone while watching us fall pregnant and have our babies with apparent ease.

Julie is undergoing this journey in the new millennium: there is more information available, and it is easier to access than ever before.  Patients are no longer forced to keep quiet and not query their doctors.  Unhappy with earlier medical consultations, she sought a second opinion.  She became an active participant in her own care, and as such Julie’s story is still continuing.  The doctors have since determined that the latest pregnancy was affected by the XX16 chromosome, one of the so-called ‘miscarriage genes’. She and her husband have therefore decided to go down the path of IVF and pre-genetic diagnosis.

‘Hopefully they will be able to find a good egg because there’s a chance that all of them have been chromosomally damaged now.  They actually had to prepare me for that.  We can go through all the IVF… and you might find all of them are damaged.  In which case you either have to find an egg donor or you give up the whole desire to have another child.’

If Julie’s story had taken place 30 years ago, it probably would have had a very different ending. She certainly wouldn’t have been sitting across the table from a friend with a notepad and digital voice recorder. Her life could have been more like Anne’s, now a woman in her early 60s, with a story she never shared.

When Anne and her husband married at 24, they immediately started trying to conceive, but with no success.  When she saw doctors Anne was repeatedly told to ‘relax and it would happen’.  During her teenage years she’d had a number of operations to remove ovarian cysts and by the time she was 27 she was back in hospital for another seemingly routine operation.

‘When I woke up there was an enormous bunch of flowers from the surgeon, and we wondered what had happened.’  In spite of this, the doctor said the procedure had been straight forward, told them to keep trying with the fertility treatments and sent them on their way.  It was only two years later, in a different city, with a different doctor that the truth finally became clear.  She had been sterilised.  Instead of removing the ovarian cyst, her fallopian tubes had been cut and there was no chance she could ever fall pregnant.

This happened in the 1970s, ‘when you never questioned your doctor’.  As a result, she never made a complaint and never saw him again.  After a few failed attempts to adopt a child, and early menopause in her late 30s brought about by the surgeries, she quietly gave up her desire to have children.

It was very much a silent point in time for Anne. She did not talk about her experiences: not with her husband, not with her family. Her friends were all getting pregnant and starting families. She never discussed her sadness with her sisters, one of whom adopted a child from Sri Lanka and then later fell pregnant anyway. Her other sister never had children, and to this day Anne is not sure why.  It was not something that was talked about.  Decisions about children, whether dictated by external forces or internal desires, were simply not discussed.

Again, I faced a grieving woman from across my kitchen table.  Anne’s sorrow was palpable when she talked about watching her friends – including my mother – all becoming grandmothers, and how difficult it can be to see them with their grandkids.  I told her she was always welcome to spend time with my children, and she smiled sadly when she said ‘it’s not the same thing.’

My kitchen table was becoming a depository for sad stories.  Over cups of coffee and pieces of homemade slice, I sat with these women as they answered my questions bravely, were patient with my lack of focus, and remained stoic as my eyes were the ones that filled with tears.  I needed a change of scenery, so I visited my friend Jane who happened to be an obstetrician, an IVF specialist and a mother.

‘How do you cope, having to tell women that their baby is dead?’ I asked.

‘That’s the really hard thing.  I have to be able to grieve myself, because I’m a human… but you also have to say “I’m your doctor”.  I can give them a hug but I can’t engage more than that because that’s not what they want.  Well, they probably do want more than that, but that’s not what they need.  You can acknowledge somebody’s grief and that’s really important, but you can’t become a part of it.’

‘Miscarriage is common but that doesn’t make it acceptable.  One in five pregnancies ends in miscarriage,’ Jane explains. ‘Chances are you know someone who has had a miscarriage but they have never told you, because we don’t talk about it.  They’re not easily spoken about.  But just because they’re common doesn’t mean they should be dismissed. I tell my patients this was your baby, you should expect to grieve.  It was going to have a birthday and an education and toys. Don’t dismiss it as a medical mishap, it’s a baby.’

I haven’t been taking notes because I have been so caught up in her words – and her super humanness.  She carries more sad stories in her heart than I can even begin to imagine, and I feel for her the emotional weight of carrying these around.  I am suddenly drawn back to the room.  Jane is telling me about the small fabric hearts the volunteers at King Edward Memorial Hospital in Perth make for the women who have experienced miscarriage.  ‘They symbolise that we recognised that it was an important and memorable event, and gave it some recognition.  The fabric hearts are something tangible…’

It is the day after my friend has had the termination.  She calls to say thank you for the bonsai tree I sent to her.  I had chosen it because I thought it represented the idea that the baby would still go on living in our hearts although it would not grow.  She tells me that she and her husband were thinking of planting a lemon tree in memory of the baby.  They didn’t know if it had been a boy or a girl, but they also wanted the lasting memorial, and liked the idea of being able to use the fruit in cooking, and sharing this food with friends and family around their kitchen table for many years to come.

After I hang up I reflect on what I have learned over the past few weeks.  I still don’t have any answers about what is the best way to approach people who have been affected by this kind of grief, but perhaps that is because there is no right or wrong way.  Every situation is different just as each of us are different.  The point though, is that we should step up and make that effort. Reach out with our hearts and our arms, our words if we possibly can.  Ask the question ‘how are you?’ and let the stories unfold.

*Names have been changed

USEFUL CONTACTS

  • Stillbirth and Neonatal Death Support sandsvic.org.au 1300 072 637 A self-help support group for Victoria and Tasmania for those who have experienced the loss of a pregnancy or newborn
  • Perinatal Loss Service Run out of King Edward Memorial Hospital 9340 2222
  • SIDS and KIDS Bereavement Service 1300 308 307 http://www.sidsandkids.org/bereavement-support/ A national service dedicated to helping families who have experienced the sudden death of a pregnancy or child regardless of cause