Holding Space for the Heartbreak: Navigating Pregnancy Loss & Infertility

Holding Space for the Heartbreak: Navigating Pregnancy Loss & Infertility

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Rachel Orleck: [: 00:00:00

Rachel Orleck, a couples therapist and coach, and together, we're going to make relationships make sense. Let's dive in.

, about how to navigate this [: 00:01:00

In this conversation, we'll discuss the impact of fertility on support, intimacy, and connection in the relationship. Ways to support yourself and your partner, and how to be a support for those going through this.

Dr. Julie Bindeman specializes in infertility and pregnancy loss and has worked with countless individuals and couples who are facing these fertility challenges.

I'm very grateful that she's bringing her wealth of experience to us today. She's a member of multiple organizations focused on maternal and reproductive mental health, is involved in training other therapists and psychologists. And is an approved consultant for EMDR. She is the co owner of Integrative Therapy of Greater Washington in Rockville, Maryland.

just a very strong advocate [: 00:02:00

Let's get into this important discussion.

Rachel: Hey, Julie, welcome to the show. It's so nice to have you here. Uh, we are going to be talking about pregnancy loss and couples who are going through infertility.

What are the things we need to be thinking about when there is a couple who's been going through this, what do couples need to know?

Julie Bindeman: Sure. Well, first of all, thank you so much for having me. I'm so excited to have this conversation with you. Um, you know, I think that, uh, when someone goes, when a couple goes through infertility, that tends to be the first kind of crisis that they experience.

e had other kinds of crises, [: 00:03:00

And then if you add to it pregnancy loss, it's like a double whammy. So it's, okay, first we have to go through infertility, and it's the cost of it, and the time of it, and, um, just all, all that it brings on a couple, the effort of it, only to find that, yay, it worked, and then for whatever reason, Oh, that baby that we have been imagining since they shared the embryo photo with us is not the baby that we're going to welcome, is not the baby that we're going to raise.

nd so they've already mapped [: 00:04:00

Rachel: Is there a difference when couples are already going through infertility and experiencing a loss versus couples where that loss is kind of a start of their infertility journey?

Julie Bindeman: Yeah, I think for those going through infertility, and again, it depends upon how long they've been on that journey for, but they're very, They might be really well aware of the peaks and the valleys of the journey, that things don't always work out, that things are not always easy.

before. Let's be cautiously [: 00:05:00

Um, I think a lot of times people don't realize that pregnancy loss is a possibility. And what I like to say, a normal outcome of pregnancy, because it happens so much more frequently than we think, or we know, or we talk about. So I just want to kind of normalize it in that kind of way. Um, and it's so unexpected because I think a lot of times the conceptualization around pregnancy is, well, if we stop birth control and have a lot of sex, we're going to get pregnant. And as soon as we get pregnant, nine months later, we have a baby. And there's no knowledge around all of the different things that can happen within that nine month period.

potential complications that [: 00:06:00

Julie Bindeman: Right. And for some ways like that might be a good thing because if I had known all of the complications for me or all of the negative outcomes that might have happened, I don't know that I'd want to get pregnant because it would feel like that's an inevitability versus These are the, like, the, um, not often circumstances, but still they're not never.

So we want to tell you about them.

But there can be other reasons that people have miscarriages, such as, um, Issues with how the uterus is constructed. There might be, um, uh, immunological issues that are going on. There's so many different things that can happen, too. So it's One of the hard parts about pregnancy loss is that it can't always be determined the why.

certainly one kind of loss, [: 00:07:00

Um, that's another time where people might not know what caused it. It might have been a cord injury. It might have been some kind of genetic issue that had been undetected. There's so many possibilities for what that is, and oftentimes parents don't get that answer, and that can be really hard as well.

Rachel: How does going through a pregnancy loss like this, um, whether it's a miscarriage, so before 20 weeks or a stillbirth after 20 weeks, what issues do you see come up in the couple in their relationship?

les have at the beginning of [: 00:08:00

So typically there's someone in the couple that's an instrumental griever, which means they're a doer. Um, and then we have a, um, an instinctual griever. So that means they're more of a feeler. This tends to be really gendered. I'm using these words really intentionally to try to un gender what these roles could be because I've seen it always.

le I'm over here talking and [: 00:09:00

I need to do, I need to create, I need to put something together, I need to feel like I am being generative in some way.

Rachel: Absolutely. Have you seen differences in how the grieving process works between hetero couples and non hetero couples?

to get pregnant, because the [: 00:10:00

And so there's always that financial piece that goes into every pregnancy. I wish that wasn't there, but unfortunately for often too many couples in this country, it is there. So to know that it's, and it's a loss that tends to be far more shared in terms of experience, even with the non gestating partner, because the dream is so connected.

t sense of being a parent is [: 00:11:00

So there's that sense of identity that gets lost. I think also there can be the sense of, um, with heterosexual couples, Often they're at reproductive age, just like their other friends are, and they're sort of all going through it together with same sex couples and queer couples that might not be the experience, so there might not be other people that they can lean on who have had the experience of loss.

Or they're seeing that everyone else is not having an issue with this, um, but we are. And I think what's really important too is that for most queer couples, and for most same sex couples, medical infertility is not part of it. It's, again, there's, there's an ingredient missing or several ingredients that might be missing, and that's why they come to assisted reproduction.

it's not because there is a [: 00:12:00

Rachel: Yeah. So it sounds like, and please correct me if I'm not getting this right, but it sounds like with hetero couples, there's this tendency to almost have it be like, yeah, this is just the process.

We're going through it with our friends and then we hit a snag or a hitch somewhere and now we have to start really planning and thinking about it. Whereas for non hetero queer couples, same sex couples, you They really start planning for it well ahead of time and it becomes much more ingrained before that pregnancy might even happen.

Julie Bindeman: Yeah. You absolutely nailed it. So.

be experiencing a pregnancy [: 00:13:00

So I think.

y of Reproductive Medicine in: 2023

So I'm very appreciative of that. Um, the Challenge in primary infertility is will we ever have a baby and when we have these losses and we have infertility that's associated with it perhaps it's really that feeling of we might never have a baby or we might never have a baby that is an equal representation of each of us.

And so that in and of itself is a whole other loss

Rachel: mean equal representation, meaning maybe having to use donor sperm or donor egg.

Julie Bindeman: Right. So equal representation, meaning, Hey, we're using the sperm and egg of a cisgender couple versus, oh, we need. someone else's ingredients in order to make this work. Um, I think the difficulty with secondary infertility is more how others respond to it versus how the couple responds to it.

So in [: 00:15:00

So not

Rachel: to mention when someone says, at least you, it automatically invalidates anything you're going through.

Julie Bindeman: Absolutely. So that's exactly what I was going to say is people will offer comfort, I'll put air quotes around that with the idea of, well, at least you have one, two, three, four, five kids. That's fine.

everal children already. Uh, [: 00:16:00

And then again, the external feedback is, you know what, just be happy with what you have. Like you're, you're putting yourself through so much and you don't have to because you already have a kid. Again, unsupportive. Well, meaning Well, meaning, um, and it's like, you know what? I think everyone knows they have an option to stop, but that is not the choice they want to make.

So, again, being able to, to, to understand that people, um, on the outside might not really understand what's happening.

Rachel: So when there might be that lack of support on the outside, and that can be true of any point in infertility, because as society we tend not to talk about it very much, so we may keep it hidden.

Julie Bindeman: We [: 00:17:00

Rachel: it's just, do it on your own. Figure it

Julie Bindeman: out. Right. Don't be emotional around me, I don't know what to do.

Rachel: Yep. I used to, when I worked in, uh, the health field, specifically, like, in clinics, we used to say that doctors can handle any fluid except for tears.

Julie Bindeman: Yes. Bad? Yep. And I would say that, you know, yeah, tears are some is a fluid that most humans have difficulty managing. For sure.

Rachel: Leads me to another question, which is once couples have had a loss, and then they go on and have another pregnancy, even a successful pregnancy and live birth, but during the pregnancy, the impact on the couple, because there has been that previous trauma and grief, and now they're going through it and maybe one or both partners are extra vigilant.

equent pregnancy after loss, [: 00:18:00

Like it did last time, but that doesn't mean that the rest of the pregnancies. fine. Like I think sometimes too in seeking out support, we inadvertently expose ourselves to way more forms of potential trauma than we mean to. So hearing about other people who have had losses all across pregnancy starts then to make it feel like, wow, pregnancy is a minefield and no one survives it.

lly. complicated too and not [: 00:19:00

And oftentimes that anxiety, it might be associated with trauma. But I think it's also important to note that not everyone experiences miscarriage as traumatic or as a brief experience. Some people experience it just as a, huh, this happens onto the next.

Rachel: Yeah. Everybody has their own understanding of pregnancy, their own expectations, and Especially if they've had difficulty getting pregnant or they are going through this and they know all the risks, then it could either impact them more or it could impact them less.

e. There are people who feel [: 00:20:00

There's this sense of like, well, it wasn't much anyway, and I'm not allowed to mourn, but being able to mourn again, that, that dream that's already been taking hold, that's the part tends to be mourned.

Rachel: That becomes really disappointing. And there's grief associated with that because all of a sudden you started imagining the clothes you were going to buy and the nursery you were going to build. And all of that occurs.

Before that first blood draw.

excited to find the answers [: 00:21:00

Rachel: Um, so when they're not experiencing that external support, but so they really only have. Their partner to lean on what kind of tension or friction can come up as you're needing support, but you're also going through your own grief and processing.

Julie Bindeman: Yeah, so what becomes really challenging is typically, as I said, there's this instinctual griever and there's an um, uh, in, oh, thank God I'm blanking on the word. Um, and I just used it. But, uh, you know, an intuitive griever and there's also an instrumental griever and. The instrumental griever doesn't want to talk about it.

eed. Neither one of them are [: 00:22:00

Um, and so there can be some resentment. There can be a sense of you just don't understand me. Why are we doing that? Like to an extreme, it might be, why are we even doing this if we can't understand each other right now? How are we going to manage as parents if we can't manage this right now? And so often what tends to be a useful way for people to handle this is to seek outside support.

So maybe that's a peer group or a Facebook page, or maybe that's individual therapy, or maybe it's finding that distant friend who's Um, because it's really hard to have an experience that is not a normed experience. As I said, I normalize it, but that doesn't mean that others do, um, and not being able to, you To get the support from people who have been supportive in all sorts of other experiences.

too of confusion or loss in [: 00:23:00

And parents are like, IVF? What's that? Or, you know, people that just don't understand. It's like, can you research it yourself? Because I'm exhausted and I don't want to explain

Rachel: it. Yeah, it's so, that's such a hard thing to do when I know when I was going through that and I was trying to explain to my family what we were doing, there were just wasn't the understanding that in my case, it was embryo donation and it was just, there wasn't the understanding that that was even a thing.

What does that mean? How are you going to do that?

Julie Bindeman: It was exciting. I hit up the store. Right. Like how do you find them?

e grocery store. It's in the [: 00:24:00

Julie Bindeman: There's sperm, there's eggs, there's embryos. Pick what you want.

Rachel: So as couples are, are going through this and they're really wanting to be each other's supports and they're not wanting this experience to, Separate them or cause more friction, especially if they're going to need to go through additional fertility treatments. What are things that they can really do to stay connected and to stay supportive of one another?

I

duling, and there's a lot of [: 00:25:00

Um, So what I like to say to people is like, you are who you are. irregardless of what treatment you need to go through. And how do you hold that identity to? Because that's an identity that quickly gets lost. Um, so what are the things you can do that, where you can stay connected to yourself? You know, if you're someone who, um, loves to go on runs and maybe that's not what you can do during treatment, okay, can you go on walks?

me to listen, or do you want [: 00:26:00

And then do as they asked and don't be like, Oh, they want me to listen, but I'm going to problem solve. Like, no, no, no, that's not what they asked for. And I think this goes both ways, because it can be useful for anyone, particularly one who's like, actually, I need to problem solve this. So I want to tell you about it.

I need your help to problem solve it.

Rachel: I can imagine that there could be some tension around that when there's the instrumental and intuitive, and then the instrumental person wants to figure out what the next step is and the other person's like, but I'm not done with this step yet.

Julie Bindeman: Right. But particularly if the next step involves donor gametes, that's, that can be really hard work.

hold on a second. This is a [: 00:27:00

Um, I think another part that gets really challenging, particularly with infertility, but also, um, With pregnancy loss in general is sex. So, you know, certainly during infertility, there are certain times in a cycle where you can't have sex or you don't want to have sex. And so being able to think with a couple about how else do you all show intimacy if it's not about potential penetrative sex?

Like what is that like for you? How might that be something? How can we think about that together?

Rachel: Really expanding the definition of what sex is.

the difficulty tends to come [: 00:28:00

And so there's that through thread that gets created, that sex means loss. And that, that then can be really hard. It's like, I don't want to go through that again. That can be really

Rachel: traumatizing on the body. And then your body shuts down and won't come alive to pleasure. Yeah.

Julie Bindeman: Yeah, exactly. And I think we forget that sex is not just about procreation, particularly when we're in that procreative phase of life, but sex is about pleasure.

Sex is about connection. Um, sex is about play and enjoyment. So there's so many more things that get attached to sex. That's not only, you know, it's procreative nature.

enhance fertility, and they [: 00:29:00

Julie Bindeman: Yeah, absolutely. Or in terms of the partner who might have to be the one producing sperm, having to do so if we're doing a fresh egg, you know, a fresh transfer, creating fresh embryos to transfer, you know, which isn't done as much anymore, but there's You know, that then means that there is a demand for sperm at a certain point, because we can't have sperm outside of the body for too long.

Um, so that creates a pressure. There can be a demand pressure too. If we're looking at timed intercourse or, uh, accentuated time intercourse, where we might be using some medication. And again, that's just like, we need to have sex now is not the most romantic thing for someone to say, you know, like, yeah, so that, and then that can be another.

r person being like, well, I [: 00:30:00

Rachel: Yeah. The pressure to perform is so hard, especially if you're getting called home in the middle of the day because all of a sudden your partner's ovulating.

Yeah. Or if you're having to figure that out. It is surprisingly unsexy. I am told.

Julie Bindeman: Yeah. Yeah. It's, it's really, really hard. Um, and it might mean that, I mean, even, even for couples not experiencing infertility and are just trying to have a baby, um, you know, the more often you try to do that and you're not successful, like the more vigilant you are around timing, the more you're looking at, well, what are the variables and.

And if you're both on the same page about that, yeah, that feels really unsexy. So sometimes one partner has to be like, I can't let him know I'm ovulating right now. I just have to have him feel like I just really want him right now. And it not so that that performance piece isn't attached to it.

Rachel: [: 00:31:00

yeah. Is there anything else that I haven't asked directly about that feels important for our listeners to know?

Julie Bindeman: Yeah, I, I want to say a little bit about how to support someone who's had a pregnancy loss. Um, cause again, we, we, we don't do so well at that. Um, I think you need to take their lead in terms of the language they use.

So if they've named their baby, use that baby's name. If they're calling it a baby, you're calling it a baby. If they're calling it a fetus, you're calling it a fetus. Um, I think it's useful to, to do. Versus to be like, let me know what you need, because you know what, when you're grieving, you don't know what the heck you need.

h yeah, that would be great. [: 00:32:00

Oh yeah. That'd be great. Hey, why don't you and I take a walk? Oh, that would be great. You know, we can talk about whatever you want to talk about. I'm not going to, I'm not going to make you talk about something that maybe you're not ready to talk about or to talk to me about. So please, please, please don't ever offer something you are not able or willing to do. Um, you know, my favorite example is I had a clergy member call me after one of my losses and he's like, anything.

You need whatever, you know, here to talk. And I'm like, Oh great. I'd love to talk. And he then tried to push me off the phone. No, it was so frustrating. I mean, it was really on brand for that person, but it was so frustrating because I'm like, you offered. Why do you offer if it's not a true offering?

Rachel: Sure.

So

ing that you can do. Did you [: 00:33:00

And that's also, what's really hard is, you know, it's not a person who has died that lots of other people knew. And we can now share stories about, but it was this very. unique time frame in which that, that baby was known. And it was a very narrow window in terms of who knew them. Um, so being able to talk about that.

So certainly when I'm with clients that experience later losses, I start asking about the pregnancy. Well, how did you find out? How did you tell your partner about it? How did you tell family about it? What was that like? You know, what were the things you were excited to do? What was that first ultrasound like?

, anatomy scan like for you? [: 00:34:00

Rachel: A lot of people are scared to ask these questions because they think it'll bring up more of the grief, but that's actually what helps people process it.

Julie Bindeman: Absolutely. It's being forced into silence for the majority of people, again, not everyone, but for the majority of people being forced into silence is really hard is the like, okay, we're not going to talk about the elephant in the room.

Um, and I think it's okay just to be honest to say I am so sorry to hear that this happened to you. And I wish I had more words that could bring comfort but I recognize there are no words. Yeah. You know what? That's honest.

Rachel: I think I might even also add that the grieving period lasts longer than we think it might.

in support and comfort that [: 00:35:00

Julie Bindeman: When people ask me when they're trying to support people, they're like, well, what can I do? I said, well, the first thing you can do is you can mark on your electronic calendar, set it as a yearly reminder when that baby was born.

So even if they were born still, you have that time of when they're born. So the next year you can reach out and say, I just want you to know, I'm thinking about you on your baby's birth on what would have been your baby's birthday. I just want you to know, like today might be a hard day, And if you want to talk, I'd love to talk.

Rachel: Yeah, they just need to know that they're not forgotten.

emory of the child that that [: 00:36:00

Rachel: that.

That's such an important point and so important for people to be thinking about. And also, if somebody's listening to this and they are the person who has experienced the loss or the couple that has experienced the loss, being able to share. Maybe this episode or share your needs with the people in your life and say, Hey, I'm not always going to be able to ask, but this is what I'm going to need from you.

Julie Bindeman: Yeah, absolutely.

Rachel: Well, thank you so much, Julie, for coming on the show and talking to us about this really, really important topic.

Julie Bindeman: I'm so grateful you had me. And again, I'm always happy to talk about these kinds of things. So thanks for having the courage to talk about something people don't want to talk about.

ing awareness and comfort to [: 00:37:00

That conversation was so powerful and I just love how Dr. Benjamin highlighted the importance of really seeking to know what your partner is needing in that space because we all deal with grief and loss differently. So assuming that your partner needs exactly what you need at that point in time can actually create more of a disconnection in your relationship and in fact lead to feeling less valued.

less understood and less connected, which isn't what you want at this stage. As you're thinking about trying again, as you're going into infertility treatments, you want to feel as secure and connected and loved as possible. So really making sure that you are asking what your partner is needing and keeping in mind that sometimes it's going to be a little bit different than what you need.

And Also, being [: 00:38:00

Bindeman's website, which is, again, Integrative Therapy of Greater Washington. The website is greaterwashingtontherapy.com.

If this conversation brought up some emotions for you, know that you're not alone. Grief and healing take time, and there's no right way to go through it.

lease share it with a friend [: 00:39:00

ening, and I'll see you next [: 00:40:00