Family planning isn’t easy for all parents. And having an uncomplicated or full-term pregnancy once does not guarantee the same results the next time around.
Parenting while coping with any form of reproductive loss, be that unsuccessful IVF attempts, miscarriages, stillbirths, and beyond can be a grueling reality for many families.
Here to discuss how to navigate fertility struggles in parenthood is clinical psychologist Dr. Shara Brofman.
If you are going through something like this right now, my hope is that this episode will help you feel understood and validated and offer you strategies for coping with grief, finding ways to move forward, and seeking aligned resources for support.
Dr. Shara (00:00):
It’s okay to stay connected sometimes to those losses. And that moving on is a misnomer, right? It’s like more of moving with.
Dr. Sarah (00:14):
Loss comes in many forms and giving yourself time and space to grieve while also parenting can be really challenging. Whether you’re experiencing secondary infertility, miscarriages, or unsuccessful IVF attempts struggling to become a parent a second or third time around can lead to some unique personal and social challenges. Here to offer strategies to cope and resources for support is Dr. Shara Brofman. Dr. Shara is a licensed clinical psychologist in private practice in the greater New York City metro area, and she specializes in reproductive and perinatal mental health.
Not all family planning is easy, and I really hope this episode will help anyone experiencing this to understand that there’s no need for shame or guilt, and most importantly that you don’t need to go through it alone.
Hi, I’m Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I’ve taken all of my clinical experience, current research on brain science and child psychology, and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights. So you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is Securely Attached.
Hey everybody, we are super lucky today. We have an exceptional guest, Dr. Shara Brofman is here. She’s a licensed clinical psychologist. She is a friend and colleague of mine and she specializes in reproductive and perinatal mental health, and we are going to get a really important lot of information from her today, and I’m so happy. Thank you for agreeing to be on that episode.
Dr. Shara (02:01):
Thank you so much for having me. I’m so happy to be here.
Dr. Sarah (02:05):
Yeah. So can you just start off by sharing a little bit about the work that you do and how you came to specialize in this area?
Dr. Shara (02:14):
Sure. So I see a lot of different range of issues. So mostly along the lines of reproductive mental health, family building, perinatal mental health, so before, during, after pregnancy, but not all reproductive experiences involve pregnancy, so all sorts of family building junctures where something may not have gone as expected or someone has been through a loss or a trauma or it’s an adjustment. It’s an adjustment process no matter what. So I support people through a range of issues related to fertility, infertility, third party reproduction pregnancy, family building without children, perinatal loss, termination for medical reasons, all sorts of related experiences. It’s all of the above, and that’s not all inclusive.
Dr. Sarah (03:13):
And it’s really rich work. It’s also very hard work. I mean, I think when you specialize, especially when we’re talking today, I have a lot about parenting after infertility or parenting after loss. This is heavy work.
Dr. Shara (03:25):
I can be. It’s also very deeply meaningful work. So it’s meaningful. I have a background in developmental psychology and in child development, and so I always think of people in terms of the lifespan. And so when people are coming to me at whatever age, I do see adults, but I always think of problems, people, stressors, people are having and ways of coping across in terms of life’s, the lifespan development. And so it’s meaningful sometimes to be with people across multiple junctures in that process. And so sometimes there are different pieces to the story that emerge and they may not be the ending that’s expected, but it can be meaningful. And I think it’s really at the risk of sounding cheesy, it’s me. It’s an honor to be with people through those experiences and people have such strength that they also don’t know about that emerges.
Dr. Sarah (04:28):
Yeah, and I’m thinking about who’s listening to this podcast right now, and it’s a parenting podcast. It’s about child development. So most of the people who are listening to the podcast are parents. But just because you have a child right now or just because you have built a family, it doesn’t mean that that was an easy process or that there wasn’t some level of pain or struggle to get to that point. And in working with families who have struggled with infertility challenges, what are some of the impacts you’ve seen on their mental health on the way that they then proceed in parenthood if they are able to have a child? What are some of the challenges you have kind of observed in people who’ve gone through that?
Dr. Shara (05:21):
Sure, sure. I mean, think in both in terms of I might say infertility, but also just people building families via reproductive assisted reproductive technology, by the way, which may not be because of infertility and maybe because of I work with a diverse group of family structures who maybe somebody, a same-sex couple went through various family building via technology. And it’s also a, can be such a stressful process and involve law. So I guess I wanted to not be inclusive but to, whether it’s fertility experiences, infertility, and/or loss it can really change how people think about themselves, others, and the world mean that sounds kind of huge, but it can be how does one cope through adversity? To whom does one go when one needs support?
What does one think about one’s identity? I’m a person who can handle things. I’m a person who can plan. I’m a person. I hear, well, we had a certain plan and this didn’t go as planned. And the lack of control, the unfortunately traumas that can occur through the process and then not being able to unknow that, oh, something bad can happen. People will describe, I’m still waiting for the other shoe to drop. I now have what I was hoping for. And I also feel like something bad’s going to happen. I feel a sense of, and they’re not wrong, that something bad can happen.
Dr. Sarah (07:03):
Right. But it’s almost like this learned dread.
Dr. Shara (07:05):
It can be. And I work a lot with ideas related to acceptance and mindfulness of that mindset, not to fail to acknowledge hope and positive potential positive outcomes and all of those things, but that the negative pieces are sometimes part of this. And you can’t just kind of rationalize out of that.
Dr. Sarah (07:29):
Dr. Shara (07:30):
I think friends and family members often try to in trying to help.
Dr. Sarah (07:35):
I wonder if that’s also another theme that people who’ve gone through this might also express when they’re working with you or they’re having a therapeutic intervention to support them, where they’re like, I’m so sick of people just trying to tell me to look on the bright side. Or everything happens for a reason, or there’s some silver lining in this, and perhaps there could be, but that’s not really always the place someone wants to sit in every moment.
Dr. Shara (08:05):
So I think it’s so hard. I think family members are doing their best to be supportive and they don’t know how to contain their own anxiety. I mean, I sometimes make a joke, well, it’s not their session, but let’s assume that maybe they have some, just as a way to tolerate those kinds of questions. You can’t control what questions or statements people make or ask or make, but that I think it can be hard for family and friends, coworkers too, they don’t know what to say. They don’t know how to code this, a perinatal loss, for example. That’s still very much with someone even, and maybe the story feels unresolved or maybe the story is resolved, but that loss will never go away. And someone saying, oh, but things are normal now. And people don’t know. People aren’t therapist. People who aren’t therapists don’t know to say, wow, that’s really, that sounds so hard. I’m so sorry you’re going through that. And they don’t have to say much more than that. But they work so hard to come up with all these aphorisms and toxic positivity.
Dr. Sarah (09:16):
Yeah. And I think it’s a product too, of a society that has notoriously kind of been afraid of grief and death and loss and pain. And this reminds me of actually an episode that I did with Heather Hogan, who’s is Death Doula. And we talked all about this idea of death being so under accessible to most people because we just aren’t, are not exposed to it. We don’t talk about it. We don’t have language for it. And so when we go through a loss, the people in our lives as loving as much love as they may have for us, and as much compassion for our pain. They don’t have language. They don’t understand what to do with their feelings about it. And so we get this awkward, anxious, icky, attempts to make us feel better. Please make this go away. Yes. I want you to not be in this pain.
Dr. Shara (10:13):
That’s right. I think that’s abs. That’s exactly right. I think it’s hard for them to be with the pain. And I think that’s right. I have a lot of thoughts about how we talk about death and loss and can we be with grief? Can we be in the lack of resolve in the idea of there’s not really a problem solving strategy in this moment and helping people to engage in things that are meaningful or rituals that help them to process those kinds of experiences. Really there are some cultures or faiths where it’s more clear sort of what to do with a perinatal loss, but not all. And what do you do when someone has lived a life and died? There is a process, there is a ritual, whether it’s faith-based or community-based, usually not alone. What can be done, whether it’s a cremation or a memorial service or burial, there’s like a thing. So there’s a thing that people know how to do. And with these kinds of losses, oh, this IVF transfer didn’t work, or I had a chemical pregnancy, I had a loss at 6, 10, 12, 18, 38 weeks what do you do with those losses and family members and friends? I think despite their best, they don’t, no one knows what to do.
Dr. Sarah (11:42):
Right. And it’s because of that, I think we end up having to feel if we’ve are going through this ourselves loneliness and aloneness. Sure. Like you said, yes, but also a sort of burden of having to reinvent the wheel every time. There’s no template for this. There’s no system for this. There’s no support for this. And not to say that there is no support and people can’t get support or the people in our lives will not try to support us, but there isn’t a set of steps that is socially understood that everyone kind of just knows to follow. Like you said, for the less ambiguous loss. Someone is born, someone’s lived, someone dies. We as a society have ways that we all have an agreed upon set of steps.
Dr. Shara (12:28):
And kind of cross culturally, right.
Dr. Sarah (12:30):
Yes. And that’s different for when it’s a more ambiguous loss.
Dr. Shara (12:36):
And then when you’re sort of parenting, having gone through something like that or you’re still going through it simultaneously, how do you manage all of that? And it can all be very isolating. And if you’re a person who used to cope by reaching out socially, but this feels harder for various reasons or more private, that can also be hard.
Dr. Sarah (13:02):
Yeah, that’s a good point. Even if you are someone who’s comfortable asking for help, there isn’t the thing you ask of a person, I’m Jewish, we sit Shiva. Right? It’s a structure. We just know it’s people just show up at your house. They just know to do it. And it’s different. You don’t have, there isn’t a language for asking for help for this stuff in the same way that there is.
Dr. Shara (13:29):
And people will minimize and say, oh, but you were only weren’t that far away. You’ll have another, you can have another, but at least it, oh, the IVF transfer didn’t work. Well, you could do another retrieval. And maybe that’s possible, and maybe it isn’t, by the way. So sometimes I help patients themselves to also recognize to not minimize it themselves. People will say, well, I don’t know if it’s so bad. My sister had such a terrible story. I don’t know why I’m having such a hard time. Or sometimes people minimize their own experiences.
Dr. Sarah (14:08):
So if someone’s listening who’s like, Ooh, yeah, definitely, that’s me. I’ve had a really hard time allowing myself permission to have grief here. What would you suggest? What are some ways, some reframes or some strategies to shift that?
Dr. Shara (14:26):
Sure, sure. I sometimes, I mean do, by the way, and it’s interesting, you’re asking me about grief, and I’m going to comment on humor, which seems like a bit of a, it seems non-sequitur or something. But I do find that’s another thing, by the way, that I find meaningful about working with people. There are ways to integrate some lightness and some humor even in inappropriate ways. But so I don’t wanna scare, I make the joke that I don’t wanna scare people in saying the grief may always be there. I don’t wanna make it sound like kind of a negative or a doom and gloom kind of idea. But act on the contrary, I think it can actually be a relief because people expect that it should have gone away. And people family members may say, well, why are you still grieving? It was a while ago.
I think the question is in the intensity of it and the intensity of it, and maybe the frequency of when it comes in or how long it lasts. And that is likely to change. So I think people can feel some relief in framing the grief, as I know you say agree with philosophically mean feelings are temporary and that the intensity of this experience is likely temporary. And so people can make space for grief to come and go. It may come and go throughout their whole lives. There’s a wonderful concept, and it did turn into a bit of an internet meme recently. I’m not sure how it kind of re-emerged, but it’s called Growing Around Grief. And it was coined, I think, by a therapist Lois Tonkin in an article in the nineties from a New Zealand publication that shared someone’s experience being in a grief group.
Do you know, you know this? No, I’m not familiar. I’m so curious. So sometimes people like this idea. So it’s certainly not, I take zero credit for this concept. I find it to be a meaningful concept. But the way this concept is described is that a particular participant in a grief support group had a loss. And this person felt that she sort of drew visually, okay, this is how I think my experience of grief is going to go. I think it’s kind of like a circle within another circle and at the beg as the loss at the sort of when the loss is acute or when it’s just happened or there’s something traumatic that’s happening in the loss, the little circle, I hope this is making sense. The little circle inside the big circle is kind of taking up that whole larger circle. And this group participant was saying, I imagine how it’s going to be as time passes is that inner circle is going to shrink and it won’t feel as hard. And she said later in the group, as a matter of fact, that’s not actually how I experienced grief. What I actually experienced is that inner circle never changed size or shape, but in fact, my life around it, that circle around it grew.
Dr. Sarah (17:48):
Oh, that’s so beautiful.
Dr. Shara (17:49):
I like the concept too. So that she began to have more experiences. She met people who never knew this person. She just had other things that went on in her life, good and bad, that had nothing to do with the experience or was just, she was growing around it. But that experience was sort of still there. And when she was reminded of it, it still really hurt.
Dr. Sarah (18:17):
But that’s like the most permission giving metaphor because I think it gives people both hope that the ratio of this pain to my life will in fact change, but the substantial of this loss will not. Right. And there’s something very validating, I think, in the permission to say, this loss never has to get smaller. This grief never has to get smaller because honestly, how can it, it’s very real and it shouldn’t change necessarily over time, but the impact of it on my life, because the ratio of its impact to my life as a whole will change. And so therefore my experience of pain will shift.
Dr. Shara (19:01):
Dr. Sarah (19:02):
But it’s like, oh, this is definitely, there’s permission for this grief or loss to stay this exact same size forever because it’s that real forever. That’s really beautiful. I really love that.
Dr. Shara (19:15):
Sure. I do too. And again, I really, I said it’s certainly not my idea, but I find it so helpful. I agree. So well, art, how you articulated that is so powerful that it leaves space for a three-dimensional experience of grief as integrating, that’s really the word, is integrating these experiences in one’s life story.
Dr. Sarah (19:38):
Without having to minimize them.
Dr. Shara (19:41):
Right in integrating them.
Dr. Sarah (19:42):
But integrated without minimization. And for those who are listening who aren’t familiar with the term integration, it’s kind of a big concept. But in a nutshell, integration is sort of combining all the pieces of our identity to form a single integrated sense of self. All the parts of us, all of our experiences and our feelings as a single whole unit. Dr. Dan Siegel, who was on the podcast a few weeks ago, he has a ton of incredible resources on this idea as well. So is, I feel like if you’re interested in this concert of integration, he’s worth looking at or checking out that episode. But in this context, it’s the minimization piece that I really think is so key here. This person in this story at the beginning, her conception of how her grief would unfold, would the pain and the grief would become minimized.
And so I think we do have this sort of implicit direction in our directives, in our life, in our world. Like the pain, we need to minimize the pain, we need to minimize the grief. That’s the task, that’s the job, that’s the goal over time’s goal. And really, in fact, no it’s not. It’s to keep growing in spite of this very real pain that does not need to be minimized for us to continue to grow. And as a result of the growth, the ratio of that pain in my life is going to just become a smaller impact cuz we are integrating all these other pieces of our identity and our experience and our relationships exactly into that bigger circle. So there’s the integration without the minimization of the grief, which I think is so beautiful.
Dr. Shara (21:19):
I think that’s, that’s exactly right. And there are, by the way, other related concepts that have to do with this same idea. This is only one of them. I think you also made me think of something else that I think is important. If someone has had a loss, by the way we know that when someone has lived and died in most cultures, it is deeply important to remain connected to that person in some way, in a relational way. Whether it’s a spiritual way, whatever it means to the individual person is that it’s perfectly healthy, not at the expense of living one’s life, but it’s healthy to remain connected to that person to what they valued to remember them. And so some people will say, I lost a pregnancy or I lost a newborn. I didn’t know that was potential of what could have been this embryo that I lost.
And it’s a potential for what could have been, but I don’t wanna forget what if I wanna hold on to the ultrasound photo or what if, and I have a healthy live child. And also I wanna that kind of idea. Or I don’t have a healthy child and I wanna remain connected. And that can be okay. And there are various things people can do where whether it’s a journal or a box or a group or an annual ritual or something that might be meaningful for people to, it’s okay to stay connected sometimes to those losses. And that moving on is not a misnomer, right? Yeah. It’s more like moving with.
Dr. Sarah (23:03):
Yes. Ooh, I like that, “moving with.”
Dr. Shara (23:06):
That’s a colleague’s also, that’s not mine, either.
Dr. Sarah (23:09):
But I think it’s true that if we’re parenting after a loss, however we ended up in this place that we’re at right now, we’re not parenting just the children that are here with us in the flesh. We have memories of either the fantasy of what could have been or the loss that really was. And I do think when you talk about trauma work and therapy for trauma creating a narrative, telling the story, making sense of it, having language, explicit language around it is very healing. And so I think any ways we can encourage parents who have experienced any kind of loss, however ambiguous it may be, however concrete it may be whether it was the loss of a transfer didn’t work, or I got no eggs when I tried to do an egg harvesting, that’s the loss procedure. Those are losses. And so to be able to tell the story and to feel that there’s some sense of meaning making, it doesn’t need to be that there’s a product at the end of it of any sort, but that there’s some way that we can make meaning of this experience for us and understand it and have language around it.
It’s a big way that we don’t get stuck in traumatic experiences and that we can move.
Dr. Shara (24:43):
Yes. I love that. To not get stuck, that’s so important. And what you bring up about the story is so important. There’s a term I love to integrate called The Reproductive Story which is from it’s from a book called Reproductive Trauma by Janet Jaffe and Martha Diamond, who are reproductive psychologist in San Diego. And it, that’s exactly the idea of the reproductive story. Here’s how I imagined it. Here’s where it didn’t go as expect. And I always say it always goes in some unexpected way. Sometimes it’s a more comfortable way than others. There could be pleasant surprises, there could be terribly challenging surprises. And can I edit the chapter, that’s Dr. Jaffe’s idea of can I edit the story to how it is now and while integrating the loss of what chapter I hoped for, or here’s the new chapter. And there’s another term that I find really helpful and to help people to frame and not get stuck, which is this wonderful idea called reproductive identity.
I love this. So it’s a fairly new concept from two years ago. Dr. Aurelie Athan, who’s at Teachers College at Columbia developed this concept of reproductive identity to encapsulate all kind of all reproductive experiences, whether they involve children or not, by the way, as an identity and as a developmental continuum. I am a person who will definitely have children. I’m a person who will definitely not have children. I’m a person that I’m not sure I’m ambivalent, which by the way is most people in some capacity. I always a person who will be pregnant. I’m a person who won’t be pregnant. These kind of conflict all these expectations about identity. And that identity can shift over time and allowing room really when we’re talking about these junctures, when maybe people come to therapy or people have a loss or trauma, they’re, something hasn’t gone as expected. But also it’s a conflict of identity. I’m not a person who has a hard time with things. I’m not a person or whatever it might be. Or whether it’s about gender or sexuality. How does that intersect with reproductive identity? And it allows room, it makes room.
Dr. Sarah (27:18):
And it gives people permission to both tell and edit. Yeah. Their story again is not necessarily maybe the story of the process, but the story of who I am and how I interpret the world around me. How I judge myself, how I see myself, how I expect others to see me. That’s also part of our narrative.
Dr. Shara (27:39):
And am I a parent now? So if people are listening who are parents, did they once identify perhaps prior to becoming a parent or perhaps while being a parent and experiencing a second another fertility experience or loss there was some sort of identity around that. People will talk about the, I’m a fertility warrior or I’m part of such and such a social media group. Well, I was in a support group specifically for miscarriage and I really connected with those people and now I’m pregnant and they’re not, and how do I belong? And all of these, and now I’m a parent, but I really had this identity as someone, well maybe I won’t be a parent. So complicated, but so can be so hard on relationships, which we need so much to go through this stuff.
Dr. Sarah (28:39):
Yeah. I mean I imagine that infertility issues, certainly loss, but all of the above can put a huge strain on a partnership and also our relationships with other people in our lives. But I would think especially a partnership.
Dr. Shara (28:56):
It absolutely can. There’s so much literature and just how it can strain partnerships and also friendships and relationships with other family and how to integrate all these complicated feelings, how to integrate. There’s a lot online about gratitude and a lot of great literature and gratitude and can I be grateful for my experience and also experience loss and also complain. I think I use a lot of dialectics in therapies that can, I also have these kind of competing experiences. And to come back to the idea of partnership, what if the two partners are having very different experiences of what happened or what is happening or different ways of coping or different ways of talking about it. And that’s pretty common. People are different to then some can the partners, do they butt heads or can they integrate? They’re each holding of the experience. They can create conflict. It could create too.
Dr. Sarah (30:00):
Yeah. But I think this idea of a dialectic is very important. And I imagine that people listening might not know what a dialectic is. Oh, sure. I, you and I probably live our lives working on things around dialectic, so can we explain it to people? Sure. Cause it’s a very therapeutic, therapeutic concept.
Dr. Shara (30:18):
Sure, sure. Do you want I can, no, we can maybe both. I should give the disclaimer that I’m certainly not a philosopher, but certainly how I use it in therapy is the idea that from two seemingly opposite truths coming together, we can create a new truth. Kind of integrating both of those truths, which seem like they can’t exist together. I mean that’s sort of one way of saying it in an accessible way. And so I can be unhappy that I had to go through so much to get here and I can be happy to be here. There was an article, there were two articles in New York Times ran in the past several years. One is a wonderful article called The Lasting Trauma of Infertility by Regina Townsend which I have notes here is from 2019 fall 2019, the Lasting Trauma of Infertility. And she talks about having gone through quite a lot and then having her son and at his third birthday still feeling the trauma and the loss. And not to say that she couldn’t also feel happiness at his third birthday, but that was okay that she wanted to name that. How could I be on, could I be sad and happy at his birthday?
Dr. Sarah (31:40):
Yeah. Two things can be true at the same time, even if they feel so utterly incompatible. And I think that if we can wrap our head around that, I spend a lot of my time with my kids trying to teach that concept. I think that’s a very handy parenting strategy in life because it’s, if you understand that essence of the human condition and can tolerate how uncomfortable that’s and confusing it is, you are going to be likely a healthier human being. You’re going to just be a more resilient person. Because I think one of the things that can lead if sort of repeated, repeated, repeated, repeated, kind of butting heads of not being able to tolerate that reality of life is a lot of defenses to, to prevent us from having to feel that conflict. So we disconnect, we avoid, we deny, we cut off.
In extreme cases we dissociate. That’s all because that conflicting feeling of I am both terrified and hopeful. Yes, I am furious and in love, I am so heartbroken and yet so happy. Yes, those are real. Just being in conflict like that as a human being is a very uncomfortable thing. And so we tend to wanna not feel that discomfort. And if we don’t understand what’s going on and have a language for it to say, oh hey, this is me feeling too competing feelings at once that I can, this is okay, this is normal, this makes sense. I don’t have to cut one off. To be able to have access to the other allows us to be more integrated, as you were saying. It allows us to have just a, I don’t know, more comfort with the discomfort of life. And so I teach my kids that all the time and my kid will be like, I don’t wanna go to school today. And I’ll be like, well, this part of you right here maybe doesn’t feel like leaving the house cuz it’s so cozy and warm in here. And maybe I’ll poke at his ear and I’ll poke at his elbow and be like, this part of you loves the sandpit at recess and this part of you right here, your little knee, that part really loves when it’s free choice time in your classroom. So it’s like, but that is a dialectic.
Dr. Shara (34:01):
He can not want to go and he can go.
Dr. Sarah (34:05):
And he can want to go.
Dr. Shara (34:07):
And he can and he can want to go.
Dr. Sarah (34:09):
And both are true and we can move fluidly between these places or we can get stuck and cut ourselves off from the complexity of it all. And I think this is super applicable for what we’re talking about in almost more profound way because the depths of the conflict is so profound, right?
Dr. Shara (34:31):
Yes. It’s so intense.
Dr. Sarah (34:32):
Experienced the loss of a child and then to have a child and to be in conflict between how much pain you are in and how much gratitude and love you are feeling is can feel it can cause us to feel tremendous guilt. Yes. Shame, right? How could I be relishing in this joy when I have experienced what I experienced and I be mourning forever? And how does that play out in the work you do with parents? I’m so curious.
Dr. Shara (35:08):
It can, I mean it can, and I think it is just about, I love what you said about how these ways of holding these competing seemingly competing truths can help us with that inevitable discomfort and it can cultivate flexibility like psychological flexibility. So yes, I mean, I was thinking, as you were talking, I was thinking when people, let’s say let’s, somebody’s going through IVF and maybe has a living child and it’s like, I don’t know if I wanna pursue another cycle, but I thought I wanted this, I should want to pursue, I do I want this, do I not want this? It’s like, well maybe it’s both and maybe it’s also just so hard. I think that’s right. I think sometimes people are so used to the brain. I think as psychologist we know about this kind of problem with the brain that we wanna categorize and it’s so often helps us to categorize and create shortcuts.
And then with these experiences you have to just help people really hold these multiple truths. But yes, it can result in feelings of guilt or shame or being abnormal. I don’t know if other people, you must think I’m crazy saying all of this and I’m like nodding no I don’t know anyone else who’s experienced it. I work by the way, with men going through men, people of all gender identities going through these experiences. And so these things are often categorized as women’s issues. And I have many, many thoughts on why that’s a disservice in language. And so I’m just thinking of, for example, male factor infer. I must be the only one. So the idea of feeling something being isolated or it can result in those feelings. And some psychoeducation, helping people to understand what even is normal is helpful.
Dr. Sarah (37:26):
And how common it is. I mean, maybe we should talk a little bit too about how just in profoundly common is, and to a lot of people that might feel surprising because people don’t talk about this stuff. There is so much in some places shame, but in other places just a lack of, I don’t know, I just don’t even know how to talk. It’s too hard to talk about it. It’s just easier not to, some of it’s just avoidance for self-preservation. Some of it is deep and profound shame some of it’s fear. And so we don’t hear how common, I think it’s becoming a little bit more common for people to share their stories of infertility and of loss and of secondary infertility and all of the stuff that fits right in this big boat
Dr. Shara (38:13):
Right? Egg and egg and sperm and embryo donation and surrogacy. It may be part of the story may be, and by the way, I always really encourage and respect people’s privacy around these issues. And also sometimes it helps people to talk about these issues. So sometimes that’s a conflict sort of how private do I wanna be? How much do I wanna share? Do I wanna share that I went through IVF and then ended up using a donor embryo and how many people do I wanna share that part of the picture or just do I just say IVF and both there’s not a wrong way to the person in the grocery store or I lost a pregnancy and actually it was a termination for medical reasons but I’m going to tell the story as a miscarriage because that feels like there’s more of a structure or societally kind of a different societal response to that.
Dr. Sarah (39:14):
And that I think brings up its own challenges when you feel like you can’t tell your whole story because sure, either it’s easier or I’m afraid of how people will receive it, or I don’t think I’ll get the same level of support or compassion. If it was a medical abortion due to a medical necessity, a very difficult choice to, to be forced to make. And how that feels a little bit not as acceptable in the grief realm as a miscarriage or a stillbirth.
Dr. Shara (39:59):
It can be more complicated. I mean, it’s important for me to hear what are people’s own kind of experiences of these losses and how much do they wanna talk about it and with whom. But yes, there can absolutely be, and again, it’s sort of privacy versus support or both can be true. You can have some privacy and you can have support. So maybe it’s okay to not tell the whole story. Sure. But maybe there’s some people that you do want to know the whole story. Maybe you tell therapists the whole story.
Dr. Sarah (40:38):
Right, it’s always helpful to have at least a place. Cuz again, this goes…
Dr. Shara (40:41):
Right, a support group.
Dr. Sarah (40:41):
back to how you can tell the narrative and have an opportunity to create the story for yourself. Because sometimes you need to say these things out loud to totally, fully make sense of them for yourself. And if we feel like we don’t have access to an outlet, to any outlet for telling the whole story and making that narrative, that therapeutic narrative, then we can have the sort of fragmentation that can happen.
Dr. Shara (41:10):
Like it can, right. And not be having things be integrated as we were using that term. And so maybe it’s a journal, maybe it’s a journal, maybe it’s a partner, a friend, a family member, a therapist, and maybe some people. And people really vary in how much they wanna process and how they want to process experience. I hope I’m not giving the wrong message of one doesn’t have to be in a support group or be online. But so are, I guess the good news is there are more ways there’s many different kinds of support for processing these experiences and some involve other people and some don’t.
Dr. Sarah (41:51):
Yeah, I think there’s this other piece that we could explore, which is how do we talk about this with our kids? If you are, how do you talk about a loss that happened maybe before your current child was born? Do we share that with them? How do we talk about the fact maybe perhaps that your child may not be biologically both parents child? And how do we talk about that and how do we talk about that in the context of creating the family story and just you say the reproductive identity, the reproductive narrative or the reproductive story, but also the family story and how sure million faculty, families come, families come in all shapes and sizes and Right. It’s not always what we read in the simple picture books or how we see it in movies.
Dr. Shara (42:46):
That’s so important. I’m glad you brought that up too. There’s a wonderful book at least that goes into conception, pregnancy and birth that you might know called What Makes a Baby.
Dr. Sarah (42:58):
Dr. Shara (42:59):
Do you know that book? Do you have it?
Dr. Sarah (43:01):
I have it somewhere.
Dr. Shara (43:04):
I don’t have it with me, by Cory Silverberg. So it’s just an example. It’s a wonderful book with many pictures. And so you asked a much more nuanced and expansive question. But I guess zooming in that’s like, that’s a place, for example, that’s a place to start. So let’s say starting with a young child often in third party reproduction disclosure in, in Now what we know about what it’s like to talk about donor donor conception, donor conceive, people kind of telling early and telling often and telling in a developmentally accessible way in a way that’s inclusive. And there’s so many, there’s so much great language to talk about loss. There are books about loss. There are books about different ways of building families and the family story and someone who wasn’t there or someone who is there. Or how to integrate the idea of a donor or a surrogate or just who’s raising you. And I love the end of that book because it says, who was waiting for you to be born? Right?
Dr. Sarah (44:10):
Dr. Shara (44:11):
Just, who raised you? Not even, I don’t even use the word parent anymore. I mean it’s, there’s so much language we can use now.
Dr. Sarah (44:19):
There is. It’s funny cause actually as you were talking to me that I was like, there is a book on my bookshelf that I just grabbed cuz I love this one. It’s called Making a Baby by Rachel Greener and Claire Owen.
Dr. Shara (44:29):
I don’t know that one.
Dr. Sarah (44:30):
It’s so good. I found it a couple, maybe a year ago. An inclusive guide to how every family begins. And it is by far the most inclusive book I’ve seen on babies. It talks about cesarean, it talks about different types of ways that another way that scientists can help people to make babies is to make sure the sperm and the egg meat in a science laboratory and it shows how it’s done and how it’s the scientists then put the embryo into the womb of the person who’s going to grow the baby.
Dr. Shara (45:05):
Who may or may not raise the baby. You just need somewhere to grow.
Dr. Sarah (45:09):
Yeah and the language that they use, the pictures are incredibly diverse and inclusive and the stories of ability and sex and size. And yes, even what happens when a baby is born too soon, why do some babies not grow? This is actually a really good book. I’m glad I thought about it. I totally forgot about that one. So we’ll put that in the show notes too.
Dr. Shara (45:31):
Sounds great. That sounds great. No, I’m glad you brought that up too. If a baby’s born too soon, which by the way can be a different kind of trauma and loss.
Dr. Sarah (45:38):
Dr. Shara (45:40):
And how do you talk about that with kids? There really are so many ways to talk to kids in ways that I think there, there’s a theme, my colleagues and I see that sometimes the person telling the story or disclosing is so nervous about how it’s going to go and the kid is like, okay. And then maybe has a different question later on. And the questions will become more sophisticated and varied with time. But a two or a three year old and so is one parent, we needed a nice person to help us with a sperm and an egg. And then, okay, can I go watch whatever. Yeah. I think sometimes the anticipation of telling it can be so normal. So that’s really the message is if it’s told in, it’s a normal, but it’s not an to not have secrecy and shame. It’s what we know now associated with the family story that it can be such an enriching part of a story and kids are curious.
Dr. Sarah (46:41):
Very curious. I think. So it’s a really good example of what I like to talk about. It’s how not the, what. Like what we end up saying isn’t really that important one way or the other to our kids, how we say it is what really ultimately matters. And so if we can normalize and talk about it early and often and in doses that feel attuned to what our kid is able to take in that particular moment in their development or in their day right then, and we just answer the questions that they ask just and leave it at that.
Dr. Shara (47:13):
Meeting them and there, right.
Dr. Sarah (47:15):
And follow their lead, but also have a tone and a body language and a facial expression that is, oh, what a great question. I’m so glad you asked. Let me give you the smallest, most relevant piece of information that’s, that answers that specific question. And then see what you wanna do with that. Exactly. And your child may very well be like, okay, great. When’s dessert? Right? Where’s my Play-Doh? Or they might be like, oh wait, how does that work? And tell me that’s more, and then you follow their lead and again, you just keep answering just the question that they’ve asked with accuracy, but appropriate language. I think our kids can handle a tremendous amount of information if we deliver it in a way that’s appropriate and tuned to them.
Dr. Shara (48:05):
Exactly. And you can do that with death and life. This is a, I’m ending on this. You can do that with death and loss too. Absolutely. That’s there absolutely way. There’re words to describe it. Okay. And Mommy was sad. And also, I’m so happy to be at your school program today, or there are ways, and that’s exactly right. Just sort of dosing what’s developmentally appropriate and seeing what’s asked. And not overwhelming a child but also being curious and being open.
Dr. Sarah (48:39):
And also not projecting our own trauma onto them. Right. Because they didn’t experience what we experienced, even though we’re talking about the exact same event. Right. They are getting it fresh. And so we can give them just information that’s not tinged with our own pain and grief and fear and all the other things. It’s very hard to do. And I certainly suggest perhaps getting support and how to do that if it’s challenging because I don’t want people to assume that because I’m saying it’s very simple, that it’s easy, it’s totally not. Especially if we have experienced a lot of trauma around those experiences. For ourselves to be able to separate that out from what we share with our child and how we share with our child is not an easy thing to do. So that’s certainly something that I would imagine you could probably help people with.
Dr. Shara (49:29):
Sure, absolutely. And having a space for yourself to be able to not then kind of, yes, project or creat more.
Dr. Sarah (49:40):
So if people are listening to this and they’re like, I have recognized myself in some of these experiences that we’ve been talking about or maybe they’re going through it and they’ve went through in the past, or they’re going through it now, what would be one takeaway you would want people to walk away from this episode with?
Dr. Shara (50:01):
I think there’s that, there’s a language there are ways to get through this that if you’re experiencing something, it’s likely that someone else has experienced at least something similar, not your unique story, but that there are ways of moving through these experiences, moving with these experiences is maybe even more accurate. And other people who have gone through similar experiences or other people who say, this thing happened to me and there’s no narrative for me out there. People are talking a lot more about a lot of these topics and I’m so pleased about that. And also, there are many nuances of these experiences that of course aren’t, or it just can’t be talked about or as well understood. Or maybe they’re less common and that there’s support and there are ways of, there’s language for these experiences and there are ways to get through it.
Dr. Sarah (51:03):
Yeah. That it’s really painful. But also there’s a universality in that pain. People have experienced loss, people have experienced grief, and you’re never alone in that.
Dr. Shara (51:20):
I think that, I think that does help some people. I think some people, at the same time, it can also be, it is so private and unique. So it’s sort of both and. Right.
Dr. Sarah (51:30):
Definitely. Yeah. And I feel like too, that there are ways, there’s a lot of different ways to get live with it and continue to live with it.
Dr. Shara (51:44):
Yes and different and making meaning and different strategies work for different people. And some people might want to do a walk or once some sort of, I meant some sort of, they contribute to an organization or they…
Dr. Sarah (52:00):
Right, like a commemorative or fundraiser kind of walk.
Dr. Shara (52:04):
Right? Or some people might have plant a tree, some people might have jewelry made, some people might have an album or some people might talk about it with other people. And there are some culturally based and faith-based ways of moving through this as well. And I bring those in just because those are, people often lean on those ways of those support mechanisms in other times of grief. And there are ways to do it with this kind of grief too. And not everyone, and that doesn’t work for everyone. But also some people find that meaningful and they don’t know it’s possible. An option to talk to a clergy person or to talk to. But again, not necessarily everyone.
Dr. Sarah (52:59):
Right. I think, yeah, that’s helpful to remember. There’s a lot of different ways to find support around this.
Dr. Shara (53:02):
Dr. Sarah (53:02):
Postpartum support International would be a good resource too, I would think.
Dr. Shara (53:08):
Yes. PSI has some wonderful support. Resolve, which is the national infertility advocacy support organization. And there are other very specific organizations specifically around perinatal loss, neonatal loss termination experiences, including for medical reasons.
Birth Trauma Association (in the UK): https://www.birthtraumaassociation.org.uk/
Return to Zero (loss on the journey to parenthood): https://rtzhope.org/
MISS Foundation (Child loss): https://www.missfoundation.org/
Star Legacy Foundation: https://starlegacyfoundation.org/
Dr. Sarah (53:29):
We’ll put the links in the show notes.
Dr. Shara (53:31):
It’s somewhere to start. It’s certainly somewhere to start. Yeah.
Dr. Sarah (53:34):
And if people wanna know a little bit more about the work you do or reach out to you how can they get in touch with you?
Dr. Shara (53:41):
Sure. So my website’s just drsharabrofman.com and I’m happy to be in touch even to answer questions or to point people towards resources as well. So even if people are out of state or have a friend that needs a website, I mean, I’m happy to be a resource.
Dr. Sarah (54:01):
Thank you. Thank you. Thank you for being here. Thank you for sharing this with us. This was, I think, very helpful and it’s a hard topic to talk about, but I think it’s a good practice for us to do that as much as we can.
Dr. Shara (54:16):
Well, thank you so much.
Dr. Sarah (54:22):
If you are experiencing something similar to these things we discussed right now, I really hope this episode helps you to feel seen and supported. And if you feel like you might need some additional support, I encourage you to reach out to a mental health professional who is trained in perinatal mental health. As we mentioned in this episode, Postpartum Support International has a directory of local clinicians, so you can find someone in your area that has been trained in these techniques. And if you’re in New York State and you’re interested in therapeutic services, you can reach out directly to my group practice, Upshur Bren Psychology Group, for a free phone consultation. During that call, we can assess your unique needs and suggest a mental health plan we feel would be most beneficial for you to reach out and to learn more, go to upshurbren.com. That’s upshurbren.com. Until next week, don’t be a stranger.
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