I work with a lot of women who are struggling to conceive and going through ART or IVF. A big part of what I do is holding space for these women to share openly and without judgement what they are going through and how they are feeling going through it.
There are recurring themes and feelings that come up in our discussions time and time again. Frustration, anger, sadness, feeling heart-broken, jealous, envious, tired, exhausted, raging, lost, anguished. This list is not exhaustive but you can see the mental load of this journey.
Another common theme that comes up time and time again is failure:
“I feel like a failure.”
“I am a failure.”
“My body has failed me.”
“I have let my partner down”
“Why has my body failed me?”
“Why have I failed at becoming a parent when it seems so easy for everyone else?”
This feeling of failure becomes SO ingrained, almost part and parcel of their life and who they are as a person.
And then, every so often, through the heartache, the medication, the cycles, and menstruation visiting every month: a miracle happens.
Everything seems to align. Success!! A sticky little embryo that decides to stick around. Time seems to stand still at this point. A new journey begins- navigating the first trimester, terrified of “failing” again.
But then, more success: a viability scan rolls around and everything looks good. A twelve week scan, a beautiful little picture of a healthy pregnancy. Success!
One of the most wonderful and heart-lifting moments in my job is when a client transfers from my Fertility Yoga into my Pregnancy Yoga class. At this point, we feel like we can get our sleeves rolled up and start to prepare body, mind and soul for a beautiful birth, the moment when they get to meet their LONGED for baby. Healthy scans and a transfer to a pregnancy yoga class- this is the epitome of success right? The complete opposite of the failure they have been feeling for so long. Feelings of failure towards themselves and their body should dissipate surely?
Well, yes and no. It is at this point they are transferred from one medical system where they are labelled a failure (“infertile”) to another medical system that cannot wait to label them a failure too.
“Geriatric mother”
“IVF baby”
“Risk”
“Red pathway”
And the word I DREAD to hear them reporting to me after their medical appointments.
“Induction”
Induction is such a common word to hear in pregnancy yoga class and not just with IVF parents, it almost becomes par for the course sometimes. A staggering one third of pregnancies are induced in the UK. If this seems like such a common thing, and seems to be the consensus of the medical community, surely we should go with the consensus and trust the medical system?
Surely not. And here is why.
In my experience, most of the women I work with, not all, but most, want a physiological, undisturbed birth. I believe this is a deep rooted evolutionary craving for most pregnant people and families, as in, it’s what the partner wants too. It’s encoded in our DNA. I also don’t believe they are selfish or delusional to want and expect this (yes, I’ve heard women being labelled selfish and delusional by medical professionals and yes, I had to drag my jaw off the floor too).
And so, on the basis that this is an evolutionary need, I work with women to prepare for undisturbed, physiological birth.
Due to the way birth is often viewed in society today, there are often hundreds of things we have to work through to achieve and undisturbed, beautiful physiological birth, too much for this blog, but maybe for another. But one thing that simply cannot be present for a physiological birth to take place is: Feelings of failure and a lack of belief and trust. Do you see where I am going with this? Induction as an intervention by its very nature is inextricably linked to failure of the body and a lack of trust and belief in the body to do it’s thing and grow and birth a healthy baby. Induction is an intervention that unfortunately wreaks havoc with the natural process of giving birth.
When discussing induction, I cannot talk or write about it without reference to the work of Sara Wickham. Her website, her research papers and her two published books, “Inducing Labour: making informed decisions”, and “In Your Own Time: How western medicine controls the start of labour and why this needs to stop” challenges the “induction epidemic” with an evidence-based approach.
A brilliant summary article she wrote for for AIMS UK on why we should always question induction is this one:
You can read the article in more detail in the link but here are the ten things Dr Wickham wishes women knew before agreeing to induction:
1. It's not like normal labour
2. It's painful
3. It's a package deal
4. Stretching and sweeping isn't benign
5. 'Natural induction' is an oxymoron
6. It is NOT the law
7. It's not 'just a trickle' (i.e. intravenous oxytocin (syntocinon).)
8. Women don't fail. Inductions and systems do
9. The post-term risk is later, lower and less preventable than people think
10. The risks for older women are not as clear-cut as is often suggested
This is a LOT to unpick in one blog post. I would encourage you to read the article for yourself and begin to peruse the work of Sara Wickham, but if we were to take away one thing to think about with induction of IVF pregnancies it’s this: Given what we know about induction as summarised above, induction should surely be avoided unless absolutely medically necessary? But this is the thing, it’s not.
When do you think women who are successfully pregnant via IVF get spoken to about induction? Earlier than you might think. I have witnessed women discovering at their booking in (12 week appointment) that they will be “induced at 38 weeks”. Written in black and white on their medical notes. No discussion, no information, no evidence, no consent. At 12 weeks gestation.
And this is the biggest problem I have with induction of IVF pregnancies:
No discussion.
No information.
No evidence.
No consent.
So why are women who conceive via IVF induced? The truth is there is not enough evidence to support why this is the case.
I was really excited with Dr. Sara Wickham published her latest book In Your Own Time. I bought it on the day it came out and dived in to find out what the latest research on induction of IVF babies was. I was really disappointed (not Sara Wickham’s fault!) that there was only one paragraph in the book citing IVF or ART pregnancies:
“There is so little evidence on induction in pregnancies conceived by IVF or ARTs that I can summarise what we know in a few sentences. We know that there is a higher chance of stillbirth and some other medical conditions for the mother and/or baby when pregnancy is conceived by IVF or ARTs, but there is disagreement about the exact level of increased risk (RCOG 2012b) and unfortunately we do not have good data on this. As I have written elsewhere, “the vast majority of babies born after IVF are born alive and well…..[and] we have no evidence about the effectiveness or safety of early labour induction” (Wickham 2018a). Decisions need to be made on an individual basis and we need more research to be carried out in this area.”
For me, the main stand out point here (apart from the screaming need for more research) is that decisions need to be made on an individual basis and in our medical system this is simply not the case. Aside from the fact that decisions on inducing IVF pregnancies vary wildly from Trust to Trust: I’ve seen a 38 week induction blanket policy, to 39 weeks just down the road in the next council area, to 40 weeks, to no induction at all unless medically necessary; there seems to be little to no consensus and above all, NO assessment on an individual basis, unless the woman gets really lucky.
In my experience, people who go through IVF tend to be in beautiful physical condition. They watch their weight. They watch what they eat. They don’t drink alcohol, or drink very little. They drink very little caffeine, if any. They take a cocktail of vitamins, supplements, and probiotics. And yet still, a feeling of failure follows them like a dark cloud even when they achieve a successful pregnancy- how could it not be when they attend their first midwife appointment and it is announced to them they are to be induced?
So, what is my point to mothers of IVF babies?
Firstly, you are an individual, demand to be treated as such;
Secondly, do your own research on induction, it does not have to be your fate;
Thirdly, question everything, and do not assume that the medical system has your back.
No one loves your baby as much as you do and wants what is best for them as much as you do.
Does this mean you aren’t allowed to want the best birth experience for you? No.
Does this mean you are not allowed to question medical interventions for your own body? No.
You are not a failure. You are capable of birthing your baby with joy and ease, regardless of whether you conceived with IVF or not.
Your birth. Your baby. Your choice. End of story.
I just want to sign off this blog with a beautiful quote from Irish midwife Philomena Canning:
“Finally, I want to say to every pregnant woman out there, and every woman who wishes to be: you have within you the great gift of creation. Therein lies enormous power and potential. Aeons of time and tides have pushed against your centre of power – sometimes gently, sometimes not. Only woman can have dominion over birth, yet she is made battle continuously to guard her territory, or to gain access to it.
Every woman has the right to be supported by her healthcare providers in the birth of her choosing – just as she has the best interests of her baby at heart. Your inner compass will show you the way. Look to it. Listen to your intuition. Sit in the centre of your courage: fear may be part of the journey but courage will overcome it every time. And please listen to my words. You were born to do this. You were born to do this.”
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