Secondary Infertility

By Nancy Stiefel
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You've already had one child, so conceiving the second should be no problem, right?

Not necessarily. Many women face infertility when trying for a second child. And although doctors can sometimes pinpoint medical causes for such "secondary infertility," the reasons often remain a mystery. For these women, not being able to understand why compounds their misery.

My own history is a case in point. I conceived my first son easily, and my husband and I expected the same results three years later. A year went by with no pregnancy, so we sought fertility testing. The results were inconclusive, but we proceeded to treatment anyway. When a few cycles of injecting a fertility-enhancing drug failed, I made the tough decision not to pursue further medical interventions and decided to explore with a psychotherapist whether there might be an emotional component to my inability to conceive.

This took time, and it was not easy. But here is what I discovered: I had firmly believed my first child's birth was just fine. He was born naturally, without analgesics, in a good hospital. He was healthy, alert, and beautiful. Yes, I had suffered a lot of pain, and yes, I was frightened and alienated during his birth. The labor was long. It seemed as though dozens of interns I'd never met examined me internally without regard to my contractions, an excruciating and dehumanizing experience. Nursing shifts came and went, other women gave birth, and I remained. When labor slowed, I was induced with pitocin, which made my contractions even stronger and closer together.

Sam was born, finally, and my husband and I were allowed to hold him for an hour before he was placed in an "isolette" and whisked into quarantine: he'd been born more than 12 hours after my waters broke, and the hospital needed to monitor him for three days to rule out infection. During my tour of the hospital, I'd been told that I could have the baby in my room, but under the circumstances, rooming in was denied. Three days later, they put Sam in an isolette under lights because of neonatal jaundice, and I was allowed to nurse him quickly every four hours. We were not allowed to hold him between feedings. It took a week to get him home.

Experiences like these are not unusual in hospital births, so when my therapist suggested that perhaps it had not been such an ideal experience after all, I argued the point. I did recall, though, that having such limited access to my newborn caused me to feel acutely depressed and hopeless. Years later, talking about my son's birth in a training group for psychotherapists, I described how many unfamiliar residents had examined me, sometimes in the midst of contractions. "Sounds like rape during childbirth," the group leader commented.

From that moment, I began to question whether the experience of Sam's birth had been so benign after all. Could my fear, pain, and despair have been strong enough to prevent a future pregnancy? As I pursued this lead in therapy, a long-buried memory of my own birth floated into my awareness. I was born at a time when babies were routinely taken from their mothers and placed in a nursery for one to two weeks. I caught a life-threatening infection in the hospital. My mother was forbidden to nurse me, and I was given only water for two weeks. At the time, mothers were discouraged from holding and comforting their infants; this was thought to "spoil" them by encouraging over-dependence. So I was allowed to cry by myself, and cry I did, for two weeks without stopping. I can't describe the sadness that accompanied this memory of my experience as a newborn. Babies who are not held by their parents in the vulnerable hours, days, and weeks after birth do not recover easily from this kind of entrance into the world.

Is it coincidental that my first son's experience as a neonate mirrored in many ways my own? And was it by chance that I finally became pregnant after taking this painful journey to my past? Perhaps. But doctors are now beginning to accept what many psychotherapists have argued from their clinical findings, and what many of us have long suspected: Emotions have a powerful influence on what happens, or fails to happen, to our bodies. And I would add that lack of awareness of our emotional history dramatically increases its power to influence our lives.

Nancy Stiefel is a writer, psychotherapist, and co-director of the Center for Aware Parenting, 360 Central Park West Suite 1A, New York, NY 10025; 212-865-7541; www.awareparenting.net. Her second son, Jake, was delivered by a midwife at a free-standing maternity center seven years after the birth of her first child.