The Perspective of a Midwife: Sitting in the Gray of TTC, Infertility & Miscarriage

Carla studied nursing in college, found energy and comfort in the labor and delivery unit, and was inspired to become a midwife. She has been practicing as a Registered Nurse and a Certified Nurse Midwife for over 13 years. She is passionate about women’s journeys to pregnancy, birth, and motherhood, and has 4 daughters of her own. She shares her perspective as a midwife on trying to conceive, infertility, and miscarriage through this Q&A series.

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TTC (TRYING TO CONCEIVE)

Do you recommend women track their cycle when trying to conceive?

“There’s this weird spot when women decide they want to get pregnant but they don’t want to become too invested in the process or have it become too much of a focus. Whether women are tracking their cycle or not, it probably is an area of focus. If you’ve decided you want to get pregnant there’s benefit in tracking your cycle. I recommend tracking your cycle because it can reveal so much about your body and can answer a lot of questions that may come up during this time of trying to conceive. I also recommend tracking cervical mucus and BBT (basal body temperature) in some instances. It’s worth trying, it’s one more piece of information.

Depending on where someone is at emotionally and mentally on this journey, I also recommend OPKs (ovulation predictor kits). One of the hardest visits I have is the one where a woman is desperate to become pregnant and has been trying for a year or longer but doesn’t have any information about her cycle or if she is ovulating. Let’s have all of this information in the first 8 months as opposed to a full year of trying and then starting to gather the information.”


Time is often a topic that women trying to conceive focus on. What is your observation about the time spent waiting during each cycle?

“A cycle or three cycles feels like a long time when you’re ready to have a baby. I think about this a lot and this links to the previous answer about women not wanting to get too focused on getting pregnant. Once you have made the decision that you are going to try to get pregnant, it is impossible to not be aware of how much time is passing. In a way, we have one chance per month to get pregnant, we then spend two weeks wondering if it worked and if we find out it didn’t we are waiting another two weeks for the next chance to try.”


INFERTILITY

People often look to their health care professionals to tell them exactly what they should do next, even if there is no clear answer. How do you respond to that?

“Unfortunately, when it comes to infertility there isn’t a clear-cut answer. Often we don’t have the answer right now, and that’s the hardest part. Even if we have an idea of what may be going on, there is still testing and labs and other things that need to be completed first. There is a societal pressure - to have the answers, to want all the information, to need to know, and that usually isn’t the case when it comes to infertility and/or miscarriage. Sometimes there is this sense that we have the answers.”

 

How often are you able to identify why a woman is experiencing infertility?

“Most of the time there isn’t a clear diagnosis for people experiencing infertility. The other part of this is that there’s not always a solution. Midwives are able to educate and inform, evaluate and order labs and tests to help get started on finding a solution, but by and large, the whole realm of infertility is not black and white. I often don’t have an answer or a way to make it better or to fix it. I tell people the longer I do this the less I feel like I know for sure.”

 

What do you see your role being when you are working with a patient experiencing infertility?

“My job is to empower women to trust their bodies and make sure they have all the information that I have and then make their own decision based on that. There isn’t a “right next step” that can be prescribed because each person may be in a different spot in their journey. It is nowhere in my scope to tell women exactly what to do but we are really good at holding the space you need to come to the decision on your own.”


MISCARRIAGE

How common is miscarriage?

“1 in 4 reported pregnancies end in miscarriage. I don’t think anyone has control or the ability to change the outcomes of these particular situations. I think the hardest part is that in many cases there aren’t answers. Women ask me what’s going to happen next and I don’t know. Most likely they won’t have another miscarriage but I can’t guarantee they will go on to have a successful pregnancy either.”

 

How do you view miscarriage from a medical perspective?

“Thinking about the whole process is truly amazing - that you can grow a human and that most of the time it goes right and it ends in a living human outside your body. I think our bodies are incredibly smart, and I think when the body identifies a fetus that is not optimal, sometimes that pregnancy will end in a miscarriage. That’s just a really amazing design of our bodies to identify if something is not going to be healthy. Of course, that’s outside of a diagnosed issue of recurrent miscarriage.”

 

How do you support patients who have experienced miscarriage that are now in the midst of a subsequent pregnancy?

“Women start to expect bad things to happen in future pregnancies. I often have to reassure women that there’s actually nothing else we need to be doing right now - you’re ok and your baby is ok. I understand the history and where women are coming from but right now this is a different pregnancy and everything looks normal. That’s hard in parenting too with a first baby versus a second baby - that’s a different baby, this is a new one and you have to do things differently each time.”