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In my practice, I have been amazed by the courage of women who become pregnant again after a loss. Working with these women has led me to wonder about the concept of “courage” and the concept of “readiness” and how it applies to the specific situation of wanting a baby and trying to conceive after the heartbreak of a pregnancy loss of any kind.

What is “courage?”

Courage is defined by www.merriam-webster.com as “the ability to do something that you know is difficult or dangerous.” Another conventional definition (www.oxforddictionares.com) states that courage is “the ability to do something that frightens one,” or “strength in the face of pain or grief.”

Certainly, these ideas apply to the women I’ve know in my practice who become pregnant after loss. That situation may or may not be dangerous physically but emotionally it almost always feels like standing on the edge of a precipice, bracing oneself for a long fall with every ultrasound and test result. And yet women and their partners sometimes choose to face this situation knowing that there is no guarantee of a healthy baby. They hold out hope for a positive outcome this time. The very act of becoming pregnant again announces, “I am willing to risk my heart to have a baby.” Or, “I am scared but I want this so much that I will face my fears.”

How does one know when one is “ready?”

Well given that no one ever feels 100% ready, it’s difficult to suggest that there is any one sign. Some people assume that in order to try again, they need to feel an absence of fear or anxiety. If this were the case, I don’t think that any women who have had a perinatal loss would try again.

I believe that readiness requires courage but acts of courage may not look like what you’d expect.  Courage is taking one small step toward a new pregnancy and doing so while still afraid.  It can be in the form of a pre-conception visit or re-starting a prenatal vitamin. Or it is simply allowing oneself to imagine what a new pregnancy might feel like.   While distraction has its place in coping with grief and eventual healing, the act of deliberately thinking about a future pregnancy may in fact be the most challenging and most courageous thing a woman can do after a loss. And while this may not equate with readiness, it represents a big step forward.  Tolerating one’s grief while also focusing on the future is exactly what will be required for the 9 months of a new pregnancy.  A new pregnancy never replaces all the feelings of sadness–sadness and loss exist side by side with hope.

The quality of one’s support network may factor into a woman’s readiness to try again as personal factors including her pre-existing manner of coping with stressful situations.  Clinicians working with clients who are dealing with perinatal losses should stay attuned to clients’ fears while celebrating small acts of courage that clients may consider to be routine or of no special importance.  Exploring the meaning of small steps forward to the individual will go a long way toward helping the grieving mother stay connected to the baby who died while still moving forward.  The grieving mother may take a step forward and then one step back in her effort to manage the tension between the loss itself (and its concomitant feelings of sadness, guilt, and fear), and the desire to be pregnant again.

Courage has many definitions but some acts of courage might be invisible, less dramatic, and person-specific.  While attending a good friend’s baby shower might be considered to be courageous for some, for others it will be setting foot in the mall where there will most certainly be babies and strollers and pregnant women.   The following quote is attributed to Ambrose Redmoon and is one of my favorites:

“Courage is not the absence of fear, but rather the judgment that something else is more important than one’s fear. The timid presume it is lack of fear that allows the brave to act when the timid do not. But to take action when one is not afraid is easy. To refrain when afraid is also easy. To take action regardless of fear is brave.”

What other acts of courage might be noteworthy in the consulting room?

 

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