Having a baby when you want to have one

Yep. I chose a big topic for my first post (aside from my introductory post which you can read here). Good thing I have an insanely big cup of tea next to me. Let’s do this!

Fertility has come up a lot over the last few years of my research career, particularly at present in my PhD on women’s experiences of endometriosis. Conception, pregnancy, labour, birth, and post-natal care are all things that really interest me as a researcher. 

We don’t talk about birth - and what comes before and after - in our culture (see here for a great example of when we do). It’s rarely spoken about among family and friends, or depicted in detail in popular culture. This has contributed to many misconceptions about birth. For example, did you know that lying down on your back to birth is associated with a longer, more painful labour? (You can read more about that here.)

Before I became a researcher in women’s health I had little idea of what having a child entailed. When I first came to be exposed to people’s experiences of it and the meaning they gave to it when completing my honours thesis I was shocked. This baby making thing is kind of a big deal! Why aren't we talking about it and sharing our experiences of it more?!

I would like to share some key points I have learnt about the whole baby making business throughout my research career thus far. Please note that fertility is about both women and men; given my research interests, I have focused on women only here.

Fertility fact #1: Getting pregnant is a lot harder than you think.

Much of my youth consisted of well-meaning people telling me that if I so much as look at a boy I will get pregnant. A lot of people who experience infertility often express frustration at school sex education programs and health professionals for spending so much time on how to avoid becoming pregnant and little on how to become pregnant. I don’t blame them; we need a more balanced approach.

A healthy woman under the age of 35 has a 20% monthly chance of falling pregnant [Younger me: Umm what? I thought it was 99%!] and about 80-90% will become pregnant within a year of trying. If you don’t want to get pregnant this isn’t a good reason to stop using contraception. But if you would like to become pregnant later you may want to keep this in mind and consider how it will fit in with other life goals you may have (e.g. for your relationship, career, travel); more on this later.

Fertility fact #2: Age is the single most important factor affecting a woman’s fertility.  

For a long time I rolled my eyes every time I came across something that went on about conception and a woman’s age, even if it was a peer-reviewed journal article. I thought it very unlikely that all women’s fertility suddenly declined at 35 and was fairly convinced that all the media and work generated about this was just the patriarchy annoyed at women for doing things besides (or in conjunction with) having babies. (Note: this is still the same reaction I have when seeing this mentioned on TV, particularly on breakfast television shows. They rarely include evidence but always include judgement. So much judgement. Of women only and not their male partners.)

It wasn't until I realised how difficult it is for a healthy young woman to get pregnant that age began to be a significant factor to me. For example, by the time a woman turns 40 her monthly chance of conceiving is estimated to be 5% (compared to the 20% I mentioned above). Everyone is different; for some their fertility may decline much earlier while others may be much later. There are options to assist those whose fertility has declined; however, these vary in effectiveness, are expensive, and are often emotionally and physically draining.

Fertility fact opinion #3: Reproductive life plans should be taught in sex ed and encouraged by health professionals.

[Younger me: Well that was depressing. What the hell am I supposed to do if I want to have a baby in the future?]

A reproductive life plan is where you think about your goals for your life and then how having children fits in and around these goals (you can find a great example of one here). For example, I recently read about a woman who said that her career was important to her and so was having children. She decided she would dedicate herself to building her career and at the age of 27 she would (if she didn't have a partner) use a sperm donor to have a baby. She intended on only working for companies with good maternity leave and flexible working arrangements to accommodate this.

Obviously everyone’s plan will be different and while some may very much want to have children they may only feel comfortable doing this in certain ways. Uncontrollable factors such as sexuality and the need to use assisted reproductive technologies (e.g. IVF), access to health care, and financial status may also contribute to how and when you are able to have children. Even if you think you will never want to have children it may be a good idea to think about how you are going to do this (e.g. I will use long-term contraceptives such as the Mirena or Depo-Provera injection, I will avoid having sex, or I will have a hysterectomy [read one woman’s experience of this here]).

I think it’s an important conversation to have with yourself, and your partner if you have one and feel comfortable to do so. While it can be a difficult topic to think about at times, doing so may help you to plan your life in a way that will accommodate all of your goals. This is something that I often hear from people who have experienced infertility: I wish I had of known sooner how difficult it would be so I could have planned my life differently.

Fertility fact #4: We do not know how likely it is that a woman with endometriosis will experience infertility.

This one is for women with endometriosis. Much of the available information on websites and in brochures about endometriosis (and even some peer-reviewed journal articles unfortunately) claim that 30-40% of women with endometriosis experience infertility. This statistic largely stems from a study conducted in the 1930s!

While it appears that women with endometriosis are more likely to experience infertility than those without, there is no good quality evidence to suggest how much more likely they are or why this is. Also, please note that I (along with many others) use the term ‘infertility’ to refer to the inability to have a baby when you want to have one – not the inability to have a baby altogether.

My advice would be to consider a reproductive life plan with the knowledge that having endometriosis may make it slightly more difficult to get pregnant. For example, you may decide that you would like to start trying to have a child as soon as you have a steady income instead of waiting to have steady income and a home that you own. For some, thinking about the things that can be controlled makes them feel better about facing potential infertility.

I realise that much of this post may not be helpful to those currently facing infertility or to those for whom a reproductive life plan may mean little (e.g. what happens if you don’t meet someone until you’re 40, and you’re not comfortable conceiving with a sperm donor and being a single parent?). My hope is that this blog post can make (a most likely small) contribution to the cultural conversation on fertility to improve the reproductive healthcare that all receive.

Kate xx

P.S. For more information on this topic I highly recommend the following:
I couldn't find anything that was particularly good for people who do not identify as heterosexual. Clearly this is a gap that needs to be filled! If you know of any feel free to share.

Image via Death to the Stock Photo