We did a recent show on Miscarriage/Recurrent Pregnancy Loss and one of the questions we received was whether to take aspirin to prevent miscarriage.  The attitude of the questioner was that basically nothing else was working, so what do I have to lose.  Some recent research addressed this question.  One well designed study in The Netherlands followed 364 women with unexplained recurrent miscarriage.  This was a randomized, placebo-controlled trail, which is the gold standard for research.  The study lasted four years.  Some women were given low dose aspirin, some women were given low dose aspirin combined with low molecular weight heparin, and some women were given a placebo.  The doctors, patients, and nurses did not know which medications the women received.  The researchers found that neither aspirin, nor aspirin combined with low molecular weight heparin, improved live birth rate more than the placebo.

However, another study found that for certain women with recurrent miscarriages, low dose aspirin with low molecular weight heparin did improve pregnancy outcomes.  This study followed 156 women in India, 75 with Polycystic Ovarian Syndrome (PCOS) and 81 without PCOS.  All the woman in the study received intravaginal micronized progesterone twice daily.  The women with insulin resistant PCOS took metformin throughout their pregnancies.  The researchers found that the only group that benefited from the low dose aspirin and low molecular weight heparin were women with very high levels of homocysteine in their blood (classified as hyperhomocysteinemia).  Hyperhomocysteinemia was more prevalent in woman with PCOS.

One of my favorite sessions that I attended at the European Infertility Medicine Conference (ESHRE) answered the question of how long should you wait after a pregnancy loss before trying again.  To me, this is science at its best—answering a real life question faced by millions.  Couples are often counseled to wait 6 to 12 months before trying to conceive again after a miscarriage.  Scottish researchers looked back at 30, 937 women between 1981 and 2000 that conceived after a miscarriage.  They found that woman who conceived less than 6 months after a miscarriage were less likely to have another miscarriage, less likely to have an ectopic pregnancy, less likely to have a pre-term delivery, less likely to deliver by caesarean, and less likely to have a baby with low birth rate. The researchers concluded that there were no advantages to waiting to conceive after a miscarriage.

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• 3.65 times more likely to develop gestational diabetes
• 2 times more likely to develop preeclampsia
• 2.55 times more likely to deliver pre week 32
• 1.69 times more likely to deliver via cesarean section

The researcher speculated that these outcomes will be worse in countries without nationalized free health care.  It is unclear at this point whether these outcomes are the result of the PCOS or the weight.  Research is ongoing to answer these questions.  We plan on interviewing the research team for the Creating a Family show when this research in published

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Aging and Male Reproductive Health

Embryos do not show a gender differentiation until 6 weeks, but the beginnings of testicles are apparent (if you really know what you are looking for) at 8 weeks.  At 3-6 months after birth, male babies go through a mini-puberty with rises in testosterone that equals mid puberty.  The reasons for this mini-puberty are not clear, but they think it may have something to do with priming the brain for maleness.  Testosterone drops of dramatically until puberty.  Scientists do not know what sets of the pubertal clock (yes, that is an actual term), but there is strong evidence that the age of puberty is dropping, most likely caused by environmental factors.  Unfortunately, they did not discuss what environmental factors were most suspect.

We all know that it possible for a man to father children into old age (the oldest man to do so was 94), but it is surprisingly hard to study from an epidemiological standpoint if male fertility declines with age, since the male factor is masked by the decline in female fertility with age.  To study the effect of age on male fertility a population is needed where:

• Contraceptives are not routinely used
• High quality records are kept
• Greater acceptance of older men married to younger women

The Mormons have historically provided such a population, and studies of this population have found that male fertility declines only slightly with age, and doesn’t begin men are older than 70.

The presentation, however, supported the findings that there are genetic hazards with older fathers.  Miscarriages are more common with older fathers.  Psychiatric problems are higher in the offspring of older father, such as bipolar, schizophrenia, and autism.  The presenters went into little new details on the increased prevalence of these mental illnesses since this was not the subject off their research and they were simply summarizing the existing research on this topic.

Safety in Assisted Reproductive Technology

The session on Safety in Infertility Treatment was disappointing since most of the presentation focused on safety risk for women with Turner syndrome. Bottom line: assisted reproductive technology should only be used with extreme caution for women with Turner syndrome.  I was more interested in the very short part of the presentation on the health risks for children conceived through ICSI.  They basically summarized the recent research which has found that 118 children born after ICSI and studies at age 14 had a increased fat accumulation and different fat distribution than a control group of children conceived naturally.  In all other respects, the ICSI group was comparable to the control group.

Other health/safety news from the conference is that overweight women undertaking fertility treatment are twice as likely to miscarry as women with normal Body/Mass Indexes.

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As a general rule, I hate the hyper-focus on using just the right words.  As Lisa pointed out in the discussion we had on the Creating a Family Facebook group about the blog Why Not Just Adopt, we are all guilty at times of offending someone inadvertently.  Sometimes we simply don’t know the correct words to use, and other times we speak or type without thinking of the impact of our words.  I know this better than most since I am on the air every week, often talking about sensitive subjects.  We have consciously decided to not avoid topics that we think will help someone for fear of offending others or for fear that I’ll put my foot in my mouth.  I do my best, but I’ve make mistakes.  We all have.  Most times people don’t mean to hurt.  But words matter, and words often reflect deeply held beliefs or misconceptions.

People really do wonder why an infertile couple doesn’t just quickly shift to adoption.  A kid’s a kid, right???  People really do believe that adopted children aren’t as fully “owned” by their parents, as a child born to them.  They are obviously an inferior substitute to the real thing, right???  Such ignorance is difficult to know how to handle.

As much as it pains me to hold my tongue, sometimes silence is the best option–the conversation too fleeting, the person too intransigent, the timing too awkward.  However, when possible, I think we should speak up for ourselves, for other infertile people, and for our children.  Although I know how hard it is to do, it really is best to assume that the person is ignorant, not malicious.

I employ the “educate briefly then change the subject” approach.

Clueless: For goodness sakes, why don’t you and Harvey just adopt?

You (suppressing a sigh): Infertility and adoption are both pretty complicated issues, and we’re considering a lot of options.  How in the world did you make this delicious bean dip? (Unsaid: Looks like Open (a can) and Dump (in a bowl) is the best you can do.)
OR
You: Neither infertility treatment nor adoption is easy or quick. Thanks for the suggestion, though.  By the way, I love your shoes.   Where in the world did you get them? (Unsaid: Do you think we have been trying for 3 years and haven’t yet thought of adoption?!?)

Ignoramus:  Adoption is just not the same as having your own child. OR Too bad you couldn’t have kids of your own. OR Is that your real child?

You (valiantly resisting the urge to smack the offensive mouth): Adoption and giving birth are certainly different ways to have a child, but either way, the child will be 100% ours.  Isn’t this a wonderful reception?
OR
You: Actually, we feel very blessed to have this wonderful child of our very own.  Can you believe the weather we’ve been having?
OR
You:  Yes, this is my lovely daughter; and yes, she is very real.  I’d offer to let you pinch her to make sure, but she’d probably scream a very real scream.  (Unsaid: And I’d have to hit you with my very real fist.)  Now, excuse me while I get back to squeezing these melons.

I know this is a bit naïve, but in some ways what offended me the most about the comments was that some of the most offensive and insensitive comments came from women.  I know that women don’t have a corner on the family desiring market, but honestly, is it too much to ask of other women, most of whom have or hope to have children, to at the very least understand the pain of someone who is struggling with this most basic desire?  Hey ladies, we need to support one another. Your path may not be mine, but I can at least understand your desire to be on the journey.

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The statement that adoption is not the same as having a child of your own is both remarkably accurate and remarkably wrong.  The first part—“not the same as”—is quite true.  Adoption and giving birth are two very different ways of creating your family.  Just as New York City and Paris are two different vacation destinations, or chocolate and vanilla are two different flavors of ice cream.

Adoptive parent don’t get to experience the joys and pains of pregnancy and birth.  They don’t have the visual proof of impending parenthood and the communal sharing this elicits.  They miss out on the wonder of seeing a tiny foot or head or butt make waves across the belly.  They don’t get to indulge in the pregnant parent’s favorite pastime–playing Guess the Gene. “Whose nose she will have” or “Will he get grandma’s gigantic feet?”  They likely won’t get to breastfeed exclusively.  The expense of adoption, while often similar to the expense of giving birth, is covered by the adoptive parents rather than insurance.  And then there is the worry about the unknown–prenatal exposures, genetic conditions, emotional state of the expectant mother, and on and on.

We seem to focus so readily on what adoptive parent miss by not giving birth that we overlook what parents by birth miss by not adopting.  As a mother by birth and adoption, I have often felt a little sorry for people who haven’t adopted.  They have missed so much.

If you haven’t adopted you haven’t felt the breath holding excitement of “getting the call” announcing that a birth mother has chosen you (domestic adoption) or that a child has been referred (international adoption).  You’ve missed the wonder of meeting a fully formed human being that is your child, complete with all the unspoken possibilities of that relationship.  Oh, and you’ll never have the pins and needles sensation of waiting to travel to pick up your child whether you’re driving across town or flying across an ocean—making lists, packing and unpacking, giggling at absolutely nothing, and worrying over absolutely everything.

People who’ve never adopted have never felt the overwhelming intensity of first meeting their child.  It’s hard to explain the giddy anticipation mixed with unnamed anxiety.  This combination of emotions helps etch even the tiniest details into your memory forever– the colors, the smells, the words, the emotions.  For me, this moment is one of my “mountain top experiences”.

Adoption can make the everyday seem miraculous.  The moment when this child that you met only a few months or even weeks before seeks you, and only you, out of the crowd with her eyes.  The moment when you realize that your small developmentally delayed child is now a robust into-everything preschooler, and the quiet pride you feel knowing that but for you, these gains may not have happened.  The contentment in knowing that you took a risk and it paid off.  A feeling of satisfaction unique to adoptive parents when we look around our Thanksgiving table and realize that we are a family created by choice and love.

Yes Marie, you’re so right.  Creating a family by adoption is not the same as creating a family by birth.  You couldn’t be more wrong, however, about the “child of your own” part.

I’m not exactly sure what Marie and others meant by “a child of your own”, but it implies a desire for a child who looks and acts like you.  A child you conceive will share half your DNA, and while it’s true that appearance and certain characteristics are influenced by genetics, what’s most interesting from research, as well as from my personal experience, is how little of our traits, personality, and intelligence are controlled exclusively by our genes.  (I highly recommend the Dec. 9, 2009 show we did on Nature vs. Nurture).

A child conceived and born of you and your spouse will be a mixing of two different gene pools, with a unique environment thrown in for good measure.  Your child by birth may be nothing like you at all.  I can honestly say that I am no more similar to my kids by birth than to my kid by adoption.  And for the record, similarities are overrated.  Being similar to a child doesn’t guarantee closeness or parental enjoyment.  In fact, sometimes it means just the opposite.  Also, it’s easy to find similarities with all your kids, if you look for them.

I suspect that those who made the comments are seeking a feeling of “this child is mine”.  But what they are missing is that this feeling comes through the acts of parenting.  Sure, giving birth is one act, and a big darn act at that, but parenting is made up of thousands of acts each day, and it is the sum total of all these acts of claiming that creates this feeling of “owness”.  Biology has little to do with it, unless you make it.

I worry a little when I hear the word “own” used in relation to our children.  I am sure that Marie would assure me that she wasn’t using “own” in the possessive sense, but I wonder.  I know that before I had children, and even when my children were young, I thought of them as an extension of myself.  It was only after my children grew older that I completely grasped the concept that I am only along for a short part of the ride.  I can influence and guide, but never own.  Don’t worry, I’m not going to go all Kahlil Gibran on you, but your kids are never really yours regardless how they join your family.

I can hear it now, all these things I mentioned that are special about adoption are not necessarily unique to adoption.  Parents by birth can and do have some of these same experiences.  True enough, but doesn’t that help make the bigger point?  I have always realized that I am immensely blessed to have had children by both birth and adoption. I can’t imagine not having had the joy and excitement of doing it both ways.  Neither way is superior; both are special, and both are great ways to have a child of your very own.

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Juxtaposing a story of sadness and acceptance into the usual mix of joyful motherhood essays was an inspired choice by Lisa Belkin, the chief columnist for “Motherlode”, adding a nice balance to this Hallmark inspired day.

So far, so good.  But then there were the comments. Most were either empathetic, having suffered from infertility, or sympathetic, having the ability to feel her pain without actually having experienced it.  But more than a few were callously clueless.

• DH: This is ridiculous. What does she expect, for the holiday to be taken off the calendar and for nobody to celebrate their joy openly, just because of a handful of women like her? …Another thing that struck me as selfish is how the woman now considers motherhood a theoretical concept that she will never experience. I’ll probably be joining a lot of other voices in asking, what about adoption? Birth isn’t the only way to become a mother, and if that’s what this woman wants, then I don’t see why she can’t adopt a baby and stop overdramatizing.
• SacMom: Why can’t you adopt? What about a surrogate? Or go through foster care program as as foster parent or as a big sister or CASA worker for foster kids or as the best auntie ever to your friend’s little ones. There are other ways to be a “mother” other than biological. I’m sure it’s painful to be bombarded by everything but I think there are solutions out there that are more than just having the baby yourself.
• Sue: Not having biological children of one’s own is not a tragedy.
• Uproar: Wow, 10 years of trying and testing and surgeries and fertility drugs, but not one mention of considering the most wonderful option of all – adoption. You want to be a mom. A baby needs a mom. Duh. Always amazes me how much unnatural and risky procedures women are willing to put their bodies through yet adoption never crosses their minds.

There is not enough time or words for me to address all of these comments, but as an adoptive mom and an adoption educator and proponent, I feel uniquely capable of addressing the “why not just adopt” comments.  Adoption was 100%, no really it was 1000%, the right choice for me, as it is for many many people.  It is not, however, the right choice for everyone.

Parenting mean different things to different people. Most people, and I suspect this would include most of the negative commenters on the New York Times piece, never have to dissect what they want out of motherhood.  They grow up vaguely assuming that someday they will become a mom, and then they give birth.   End of story.  But if you are infertile, you have to go the next step to decide what motherhood means to you.

Some people decide that their ultimate goal is parenting.  They want to go through the process of raising a child: the wiping of droolly chins; the flat footed ballet recitals; the sitting on the bench of endless ball games; the Christmas morning chaos of paper, cookies, and wonder; the sleepovers; the teaching to drive; the senior prom; the coming home from college; the grandkids.  These folks have options if they find themselves infertile– donor eggs, surrogate, or adoption.   I don’t want to minimize their pain at losing a biological connection, or their need to grieve this loss, or the financial costs, but they can and most often do, move forward to become happy and content parents.  For them these Plan Bs are an alternative path to their real goal of parenting.

For others, their dreams of parenthood are not so simple.  Yes, they want to raise a child, but not just any child.  They want and need the biological connection to this child.  They crave the genealogical continuity.  They are too wounded by infertility to risk adoption.  Most people I talk to who feel this way, wish they didn’t.  They wish they could just accept the Plan B of adoption or donor gametes.

Rather than judge them as a failure or as selfish for not being able to accept the more conventional second options, I respect them for knowing what is right for them and not trying to blindly make adoption or donor egg fit.  If it is not “right” for them, it is also not right for any child they might have had through donor egg or adoption.  Knowing yourself and having the courage to act on this knowledge is powerful.   They make this decision knowing full well that others will not understand and will judge them if they express sadness about their choice.

I sense undertones of blame in some of the comments.  An attitude of “You made this choice, so now live with it.”  Life, however, is full of choices we’d rather not make.  A friend of mine “chose” to have a mastectomy when she was diagnosed with breast cancer.  Others in her position might well have chosen a lumpectomy, but given her family history and her propensity to obsess, she decided that a mastectomy was best for her.  Just because she had a choice, doesn’t mean she’s not entitled to feel the grief of this choice.  The same can be said for those who choose to live childfree.  Most days they own their decision and make the best of it, but sometimes they think about what might have been.  Mother’s Day is often one of those times.

I also sense a bit of sanctimonious holier-than-thou stuff going on in some of the comments.  “If you were a better person, you would ______(adopt or foster a child from foster care, become an uber aunt, etc.).  I wonder how many of those who are making these suggestions have themselves adopted from foster care or forsaken parenting in favor of being the world’s best aunt.  No one way of dealing with infertility is morally superior to all others.

How anyone can feel anything but compassion for those suffering with the disease of infertility is truly beyond me.  At the very least, they can try to be open to their pain.  Saint Francis got it right when he prayed:
O divine Master,
grant that I may not so much seek to be consoled as to console;
to be understood, as to understand;
to be loved, as to love…

To hear Pamela discuss why adoption was not the right choice for her, listen to the Oct. 7, 2009 Creating a Family show.

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Top Ten Myths about Infertility

1. Just relax.  OK friends, if relaxing were enough to do it, we’d all get pregnant the first month we ditched birth control, bought that really good bottle of wine, and lit the candles.
2. It’s your fault because _________ (Take your pick: lived the fun life and postponed starting a family, had sex too young, work too much, enjoy sex too much (or is it too little?), are overweight, are underweight, don’t like your sister’s kids, were ambivalent about becoming a mother, etc.)  Fault has no place when talking about a disease.
3. It’s usually caused by a problem with the woman.  I can’t tell you the number of people I talk with that go through invasive and expensive testing of the woman, only to find out from a simple and cheap sperm analysis that the problem is with the man.
4. Your Ob/Gyn can handle most fertility problems.  Although your initial consultation and treatment can start with your gynecologist, after 6 months (over 35) or a year (under 35) get yourself to a reproductive endocrinologist.
5. Infertility treatment is always successful.
6. Just keep trying, look at ______(fill in the blank with the name of any 40 something actress), she just had twins.
7. All this “trying” must be fun! *wink*
8. You are selfish to want to be pregnant or to create a child with your spouse.
9. Adopt, then you’ll get pregnant.
10. All these new fangled treatments like donor egg and surrogacy are against nature.  If God wanted you to be a parent, you would get pregnant.

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There is some evidence that she’s right.  Parents who have struggled to conceive make very good parents.   Research shows that families created with the help of fertility treatment compare favorably with families that conceived without treatment, especially after the first 12 months.  There is some research that infertility patients are more anxious during pregnancy and their child’s first year of life, but the anxiety usually passes after that.  Parents that conceive through IVF tend to be more protective of their children; more child focused; and show greater warmth towards their children.  These studies have been small, but this supports what I see in real life.

Parents who chose to adopt rather than stay in infertility treatment also make great parents.  Studies show that adoptive parents invest more time and financial resources in their children than biological parents and “evidence a high level of strength in terms of warmth, communication, discipline, and cohesion.”   Researchers speculate that “One of the reasons adoptive parents invest more is that they really want children, and they go to extraordinary means to have them.” Amen to that.

I have to admit that I worry about the effect of over protectiveness on kids, but I think our entire generation of parents is over protective, not just parents that conceived or adopted after years of trying.  I don’t think we have a good grasp on how to weigh relative risks.  We are overly worried about low chance risks such as stranger abduction; as a result we micromanage our kids’ lives because we are afraid to let them out of our sight.  The older my kids get the more I believe that children need to learn certain lessons from failure and falling and figuring things out on their own. But that is the subject of a different blog.

Parents that have had to struggle to become parents sometimes have a hard time giving themselves permission to have the normal feelings of frustration that comes along with parenting.  (See last week’s blog about a mom through surrogacy and donor egg.) They may feel let down after all the years of anticipation.  They may think they don’t have the right to complain about being tired, or wishing for a day to themselves, or craving time to wash their hair and shave their legs.  But fortunately, these feeling also usually pass with time.  Most parents of two year olds and teens feel pretty darn entitled to their frustration, regardless how they got their kids.

Infertility can affect the quality of parenting in two ways.  Infertility treatment results in a disproportionately large number of multiple births, and much research supports that parenting twins and triplets is much more stressful on parents.   Also, subsequent attempts at infertility treatment for a second child can add significant stress on parents. I’ve not seen research on whether already having a child reduces that stress somewhat.  I would also like to see more (any?) research on how parents of kids conceived through higher levels of infertility treatment (donor egg, surrogacy, etc.) fare as their children age, but I suspect they’re doing just fine because they too have so much love to give a child.

Everyday I see and hear from people who have struggled for years to create their families.  I don’t know whether these kids are “the most loved in the world”, but I can certainly say that they are a very cherished group, and being cherished is probably the greatest gift we can give our kids.

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Dawn, since I listened to your show and read all your FAQs and resources on this journey, I thought you should be one of the first to know that our daughter has finally arrived after 6 ½  long years.  We ended up using a surrogate and donor eggs with my husband’s sperm. I remember listening to one of your shows on surrogacy a long time ago and starting to think that it might be an option. I’ve gone back and listened to them all so many times in the last 2 years.  They were really helpful in making the decision and some other shows helped us go with only transferring one embryo. Thank you.  I am really hoping you can give me some advice now.

We have been home for almost a month and it is nothing like I thought it would be. I know I sound ungrateful and shallow, but I don’t feel anything like love for this beautiful child. I have dreamed of her and wanted her for so long, but now I feel like a stranger to her. She doesn’t feel like mine and I know she really isn’t mine. I know you talked about this issue but I never thought it would happen to me. Even though I’m not related to her, I thought I would fall completely in love regardless, but that hasn’t happened.  I think I’ve made the biggest mistake of my life and I have no one to blame but myself since my husband wanted to stop a long time ago. I’m ashamed to tell him or anyone else any of this.

The myth of falling in love at first sight is powerful and pervasive.  Plenty of potentially great relationships have never taken off because of this myth, and plenty of first time parents have suffered needlessly.  We have idealized the instantaneous nature of maternal love to the point of absurdity.  Some mothers indeed feel an immediate intense love for their child, but plenty of us do not– regardless of how we became mothers.  You’re blaming surrogacy and donor egg for this lack of instant love, but others blame an especially difficult labor, breastfeeding troubles, in-laws, or adoption.  I pity the poor mom who has nothing to blame.

I have talked with enough women to believe that surrogacy and donor egg and adoption can impact the immediacy of your feelings of love.  You haven’t had the intimacy of the past nine months to develop these feelings.  Many moms through surrogacy or adoption do “fall in love” with their baby during the pregnancy, but some don’t.  The good news is that you have the rest of your life grow in love with this child.  This will be easier if you stop longing for the romanticized ideal of instantaneous love.

It’s interesting why we idealize the idea of falling rather than growing in love.  When I think of falling, I think of something quick and painful.  I much prefer the image of growing in love.  Growth implies depth, roots, and the ability to withstand the forces of life.  I have experienced the intoxication of lust at first sight and the warmth of maternal caring at first sight, but not really love at first sight.

You may not have a biological connection through genetics or pregnancy, but your daughter is 100% yours regardless.  Love is absolutely not dependent on biology.  I assume you love your husband, yet you share no DNA.  This child is yours and will share many of your mannerisms, habits, and traits.  In other ways she will be uniquely herself.  Isn’t that what we all should hope for our kids?

The depth of your despair, however, should not be taken lightly.  Post baby depression is real and is not dependent exclusively on the hormonal upheaval of birth.  Adoptive parents and parents through surrogacy can and do experience depression after the child comes home.  In part, I suspect it is the natural let down after achieving a long sought after goal.  In part it’s also because the first months of parenthood can be unexpectedly lonely and hard.  These feelings are so common we’ve done a number of shows on them ( Parenting kids conceived through Assisted Reproduction, Surrogacy , Are you Ready to Move to Donor Eggs or Sperm?,  Parenting Through Surrogacy, Parenting after Infertility, What 3rd Party Reproduction Can Learn from Adoption, Nurture vs Nature — Which Trumps in Parenting)  Unfortunately, our society rarely talks about these darker parts of new parenthood.

Loneliness can hit new moms through surrogacy and adoption particularly hard.  Pregnancy and pregnancy related activities, like child birth classes and breastfeeding classes, are a great way to find other women who are soon to be going through the trials of early motherhood.  However, once your child arrives the opportunities explode if you look for them.  Mommy-and-me type classes are very popular for everything from yoga to running to music.  Community recreation centers and libraries often have these programs for a very low cost.  It really helps to have someone to commiserate with when your darling drops a diaper bomb on your white sofa and you haven’t found the time to shave your legs in over a month.

The first months of motherhood are a lot of work done with very little sleep and few rewards.  I’ve always thought that God planned the first smile to hit at around six weeks to insure human survival.  Just about when you think you can’t keep going, the source of your exhaustion smiles at you.  Who knew that droolly toothless smiles were such a powerful fuel and aphrodisiac.

You need to ditch the shame.  You haven’t done anything wrong, and you aren’t weird or abnormal to have these feelings.  However, you do need support and help, and you need it now.  Share your feelings and fears with your husband.  He may feel relieved because he feels the same way, or you may feel relieved that he doesn’t blame you.  In fact, he may think that this beautiful child is the best thing that has ever happened.  I have no idea what he’s feeling, but this is the type of thing couples should share.

Try to establish a routine. I know this is easier said than done with a new baby, but it will help normalize your life if you have a scheduled time for a shower, for fixing dinner, and for doing the laundry.  If you can afford it, hire a sitter so you can get out once a week to do something that you like to do.

Run, don’t walk, to a good infertility counselor.  Many infertility patients struggle with unexpected feelings once they finally succeed at having a baby, and a good counselor can help you work through them.  Your infertility clinic may be able to recommend a therapist or you can use the resource we’ve listed on our How to Find a Doctor or Therapist page.

If you have had thoughts of harming your daughter or yourself, immediately tell your husband, a therapist or doctor, and your best friend or someone in your family.  Have someone nearby to call immediately if you have these feelings.  This despair doesn’t mean you’re a bad mom, just a mom that needs a little help right now.

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Hi, Dawn. I love your site, I love your manner.  Do you have any words of wisdom for families where one parent feels sure and confident in a child’s special needs file and the other one does not?

My husband and I are about half-way through our home study and intend to adopt from China’s special needs program. Last week, we came across a blog of a family who has adopted a girl with albinism. We were touched and added that condition to our list of needs to consider. Today, our agency sent out a list of profiles and there was a 3 yr. old girl with albinism. It was just crazy enough that I thought it might be God. I asked for her file, and when I saw it, I did not feel the “this is our daughter” or “just knowing” that many moms speak of, but when I showed it to my husband, he was excited and ready to pursue her. Thoughts?

Yes, I’ve had lots of thoughts.  I distrust that feeling of “just knowing’. I’m not sure why exactly.  Maybe it’s a right brain/left brain thing, and for better or worse, I’m more of a left brain type.  Or maybe I’m a little jealous of those gifted with certainty, since I’m usually stuck with questioning, second guessing, and stepping out on the limb with just faith, hope and prayer. Although this question deals with seeking certainty with an adoption, I hear it from people throughout the trying to conceive/infertility/adoption spectrum.  “I just wish I knew for sure whether __________________ (this next cycle would work, donor egg is right for me, to adopt, I’ll regret stopping treatment).  I feel your pain.

I’m afraid of heights—well, terrified really.  A couple of years ago, we went to a
Family Weekend at a nearby camp with our two younger kids. We had a great time doing family art projects, music and games and were looking forward to the promised special treat in the afternoon.  I had visions of S’mores, or at the very least hot cocoa, but when the time came our perky fearless counselor announced that the special treat was the high ropes course.  For the record, the word “treat” should only be used in connection with the words “chocolate” or “frivolous purchase of shoes”.  It should never, repeat never, be used to describe an experience involving thin ropes precariously strung three stories above a concrete floor.

Since death defying feats deserve proper attention and encouragement from the ground (and since I was scared spitless), I selflessly volunteered to be the group cheerleader.  Unfortunately, one of my kids quickly decided to join my cheerleading squad.  What a parental dilemma!  I didn’t mind being a chicken, but I did mind patterning that behavior for my child.  (Being a role model sucks!)

Sighing deeply and cursing my discomfort with hypocrisy, I told my son that I was really scared, but that I knew it was safe and that I didn’t want to miss something just because I was afraid.  He could decide for himself, and it would be OK either way, but I thought I would try the course.  He, no doubt also sighing deeply and cursing my discomfort with hypocrisy, said he would try if I would go first.

Now here’s the illogical part of fear: I was totally harnessed in and on a belay rope the entire time.  Logically I knew that I could not get hurt—embarrassed, yes; physically hurt, no.  But logic was nowhere present as I stepped out on that rope.  Making that first step took every bit of courage I could muster, and every step after was a step of faith.  I wanted desperately for a handrail to add certainty to my steps, but all I had was a very thin rope.

For me, that’s how it is with most of the big decisions in life.  I know a lot of people report a sense of “just knowing” what is right, but I seldom have it.  In fact, it almost seems like cheating or taking the easy way out.  In my mind, big decisions should be weighed; pro/con lists should be made; a certain amount of angst should be experienced.  I also wonder if others really have the sureness at the time, or if it is only after the fact that they remember “just knowing for sure”.  It’s easy to know what’s right when you see how it turns out and to forget the uncertainty, the fear, the confusion, and the fervent prayer experienced when actually making the decision.

So, here’s the truth: there were moments when I was scared to death before our adoption.  I dithered and debated with myself about whether her special needs were too big or too unknown for us to handle. Were we nuts to have so many kids?  I wondered if I was making the right decision for my children, or if I was I selfishly satisfying my desires to their detriment.

My approach to big decisions is to combine research with my self-named “preponderance of feelings” theory.  I read everything I can find, talk with people, weigh pros and cons, and take frequent readings of my emotional temperature.  If my fear and uncertainty is going up, that’s a sign to back away.  If they’re going down, even slightly, then that’s a sign to move forward.  I take a day or two where I try to walk through the day living out the decision.  What would my day be like if I decide one way or the other?

Once we accepted the referral, I had more and more moments of blissful certainty.  After I held her in my arms I was overcome by clarity.  That was my pattern.  I know that for many certainty doesn’t come the moment they hold their child.  It may arrive months later with a smile or a hug.  Some don’t ever need to know that they made the “right” decision.  For them, it only matters that this is the life they are now living.

I don’t know whether this is the child for you, and I would never tell you to put your concerns aside and just step out on faith.  What I am saying is that I wouldn’t let your lack of the mystical “knowing” be the deciding factor.  Rely on how you have made big decisions in the past?  Research albinism and all that it would mean for you to parent a child with this condition and what it would mean for your family.  (There is no better place than the Rainbow Kids Special Needs page for starting this research.)  Read up on albinism at the National Organization for Albinism and Hypopigmentation website.  Talk with your doctor and a specialist.  Analyze how well this child’s age and gender would fit within your family structure.

I suspect part of your uncertainty comes from how quick this referral came.  You haven’t had much time to prepare mentally for any child, much less a child with albinism.  If you still have a lot of fear and uncertainty after you’ve paid you dues with research and indecision, then maybe that’s your answer.  I work on the theory that each spouse has veto power over major life decisions.  It’s fair for your husband to try to educate you and sway you, but if you still say no, then the answer is no.

I wish I were a person who didn’t want the handrail of certainty in life.  I know deep down that there are no guarantees of a perfect decision leading to the perfect happily ever after, but I still envy those people who think otherwise.  For me, I’ll just have to be content with stepping out on that very thin rope with a lot of faith, hope, and prayer.

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