The other side of the fence

pregnancy testThis column was written in October 2014…

Countless consultations start with the words “I’m pregnant.”

I quickly learned not to jump in with an enthusiastic “Oh congratulations, I’m delighted for you!” Make no assumptions.  Sensitively ascertain the patient’s state of mind before celebrating or condoling.  A new pregnancy can generate a range of emotions in the mother-to-be, from despair to ecstasy, but in my experience indifference is rarely, if ever, predominant.

Likewise, I imagine that for many GPs the news of a patient’s pregnancy also triggers an emotional response in them.  The emotions felt may be simply a case of transference, they might be an inherent sense of wonderment at the creation of a new life, or they may be complex, perhaps intertwined with feelings surrounding the GP’s own reproductive history.

Barring the occasional faux pas as a result of an incorrect assumption, I think we GPs are, on the whole, very good at managing both our own and our patient’s emotions surrounding a desired pregnancy, and mostly pretty good at handling those surrounding an undesired one.  From what I’ve observed, however, many of us are far less comfortable handling those involved with a lost or non-pregnancy.

Admittedly, it is very hard to know how to respond to a desperate patient who wants nothing more than parenthood, but for whom this dream has remained elusive.  While the drive to procreate differs between individuals, for many of us, myself included, it can be an overpowering one.  The primal reproductive instinct is at the core of many people’s sense of identity and life purpose, as well as having cultural, social, spiritual, financial and familial implications.

After nine years and five miscarriages, I’m sitting here typing this as my 23 week daughter moves around in my distended abdomen, reassuringly.  On my joyful and life-changing journey through this so far remarkably straightforward pregnancy, I’ve had many new experiences.  I’ve relished discovering that my clothes are too tight.  I’ve been relieved beyond words to get the “all clear” on the 18 week morphology scan.  I’ve discovered that, despite my best efforts, I have become one of those annoying super-gushy types of pregnant women.

The most surprising aspect to me, however, has been the reactions of friends and colleagues.  Without exception their responses have been overwhelmingly positive and supportive, for which I’ve been immensely grateful.  What has intrigued me though is that many have started to treat me more inclusively, seemingly because I’m now “one of them”, a member of the “parenthood club”.  When I’ve gently explored this with a few, they’ve reflected that it has been difficult for them to juggle their desire to talk freely about their kids while being sensitive to my situation, and that at times it has been easier not to engage at all.  I know I’ve played a part in this too.

In my experience, both as a patient and as a medical educator observing doctors-in-training, many GPs face a similar struggle when interacting with patients with infertility and/or miscarriage.  Either resorting to platitudes or avoiding the heart-of-the-matter can leave vulnerable patients even more isolated and unsupported.  Unlike disorders like cancer, disclosing and discussing infertility and miscarriage publically is somewhat of a social taboo, and this, I believe, is part of the problem.

While we are told, for good reason, that it is important to leave your personal baggage at the door of your consulting room, it’s not always that easy.  We all have things in our past (and/or present) that can potentially influence how we feel about, and interact with, certain patients.  Being aware of these factors and their effects is vital, but is it always necessary to neutralise them?  Not only is complete objectivity impossible in the kind of work we do, but judicious and thoughtful use of our life experiences can make us better clinicians – and better teachers.

I hope that I can use my experience to help support both patients and other doctors in managing the complex emotions surrounding fertility issues, and also encourage more open discussion in the general community.

While immensely thankful and blessed to now be on the green side of the reproductive fence, I will never forget how painful and isolating it can be on the other side.

First published in Medical Observer, 17th April 2015

The ending to my pregnancy story was not a happy one. You can read about what happened here


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