From Interviews

The Facts of Life: an Interview with Paula Knight

Editors’ note: Dr. Elizabeth Starr recently interviewed graphic memoirist Paula Knight about her new book. Read on to learn more!

Paula Knight’s graphic memoir The Facts of Life is a powerful example of women’s work in autobiographical comics.  Recounting her childhood in Northeast England, The Facts of Life explores how we form expectations about fertility that then shape our adult lives.  Knight’s work illustrates the experience of miscarriage and living with ME/CFS/Fibromyalgia and offers alternative ways of valuing women’s lives beyond motherhood.  We’re grateful that she took the time to talk with MotherShould?.

ES: You studied Graphic Design and Illustration in college and have been writing and drawing professionally for many years. Did applying those skills to a graphic memoir about fertility and womanhood seem like a natural step—how did that come about?

PK: It was perhaps an odd step to go from illustrating children’s books to writing a book about not having children. Of course, some of those skills were transferable – certainly in terms of being able to structure and craft a cohesive narrative with so much information to juggle. My growing interest in graphic novels just so happened to coincide with the time in my life when I was trying for children (and ensuing problems), and it soon became the medium I wanted to use to tell my story, especially when I realised that other women my age were creating autobiographical comics. I began to read many more graphic novels about tricky autobiographical subject matter, especially health-related, and this made me feel that there might be an audience for my work in this medium. I also entered Myriad Editions’ (my UK publisher) First Graphic Novel Competition in 2011, and an extract from my book reached the shortlist the following year. This gave me the confidence to get on with the job after many years of ‘starting’ my book!

from “The Facts of Life” by Paula Knight, 2017

ES: There is so much silence surrounding the experiences both of dealing with miscarriage and living with a chronic illness, and there seems to be a lot of blame assigned to bodies when they aren’t working perfectly.  Your comics, for example, draw our attention to the language of carelessness or failure that is often used to describe miscarriage.  Chronic illness can also bring on feelings of self-condemnation or doubt, especially when there’s a delay in getting a clear diagnosis.  Do you think we tend to treat miscarriage and chronic illness in similar ways?  What was difficult or liberating in trying to break these silences?

PK: Yes, there appears to be just as much stigma surrounding the illness ME/CFS as there is around miscarriage, although the roots of the stigma are different. ME is a highly misunderstood invisible illness and miscarriage suffers its shroud of silence – possibly connected to shame around women’s bodily functions, and our fear of blood and death. There are also similarities such as feeling desperate to know the cause, and wanting a cure, when medicine can’t tell you what’s wrong or provide treatment, for example. Then, in absence of a satisfactory answer, the next step is to blame oneself. That vacuum also serves as a gaping receptacle for ignorant unsolicited opinions of others, unfortunately – if there is any room left in there alongside all the self-blame: Everyone gets tired; You can always try again, etc. It’s safe to say that neither miscarriage nor ME/CFS are patients’ fault – they are health issues that medicine doesn’t (yet) know how to treat fully. I try to fill some of that vacuum with comics, which, with its unique interplay of words, pictures and panels, is a medium well-placed to tackle subject matter that has traditionally been unspoken. I felt tentative about sharing the work online at first, but ultimately it was very connecting, and it encouraged conversations I would never have had otherwise. It felt very gratifying to receive emails telling me that my work has expressed something on behalf of people who was unable to.

ES: The Facts of Life makes such a persuasive argument that we could all benefit from getting out from under the sway of pronatalism: what are the things that help you do that?

PK: I’m interested in wildlife and the natural world. Environmental issues and the idea of the Anthropocene (the point in time at which human existence on earth is said to have caused ecological damage beyond repair) go a long way to comfort me over the fact that I didn’t have children. Human population growth is the greatest threat to the wellbeing of our planet and to our very own existence on it. I have a growing interest in organisations such as Population Matters and Eradicating Ecocide. Having said that, I’m not anti-natal either – I think extreme policies either way are a threat to reproductive rights (extreme pronatal policy might involve limiting access to abortion and contraception, for example). Of course I still have times of grief over not having children, and no doubt my child would surely have been a brilliant scientist who discovered new ways to feed everyone without harming ecosystems…. I also planted some trees as a memorial to the child I didn’t have. It seemed like a positive thing to do – trees last longer than people and are far more beneficial to the environment. The ritual of doing this helped immensely in our grief, too, so win-win!

ES: Some of the most powerful visual scenes in this graphic memoir depict how the ability or the inability to have children shapes the way people talk to you at parties or at work.  These casual encounters can happen so quickly, but can be so traumatic.  What do you want to say about how to talk to people who don’t or can’t have children?

EK: Perhaps we could try to steer clear of the more direct and intrusive questions. I understand that for people with children these conversations can be very connecting, but you don’t need a degree in psychology to read between the lines. Perhaps try more open-ended ice-breakers, such as: How are you?; What have you been up to recently?; Did you see Game of Thrones this week?; Where do you come from?; or How do you know *person*? This gives more scope to steer a conversation away from talk about children and avoid the risk of opening up raw wounds for someone who is hoping to have a nice relaxing evening out. Never ask why someone didn’t have children, or offer unsolicited advice. I wouldn’t ask someone why they didn’t ever do X job; or why they don’t own a bigger house, or have a partner, for example. Why didn’t you ever succeed in becoming an astronaut – whatever went wrong there? Why don’t you try buying a space suit and jumping up and down on a trampoline instead? Having said that, there was a very clever lad at my school who wanted to be an astronomer, and I would really like to know if he made it. It’s natural to be curious, but you don’t have the right to know personal details about someone’s fertility problems – and that’s what you might find yourself inadvertently poking around in when you ask someone if they have children.

ES: Do you have any advice for women who “can’t draw” but might want to after reading your book?

PK: I don’t believe in ‘can’t draw’ – anyone can! You don’t have to be a trained artist to draw – you weren’t when you were a child, after all. You didn’t care if it looked right then, so why now? It’s still possible to communicate an idea or emotion using stick figures or very simple drawings. Don’t let draughtsmanship, and not being able to represent subject matter accurately, put you off. It’s good to carry a small sketchbook and pen/pencil around at all times and that way you can fit in some drawing whenever the opportunity arises – in a café, work canteen, or on the train etc. Drawing from observation in this way is great practice, and you’ll never forget an idea if you always have a sketchbook or notebook with you.

Learn more about Paula’s work at her website, and follow her on Facebook, Twitter and Instagram




Elizabeth Starr teaches writing and literary study at Westfield State University. Her academic work brings nineteenth-century narrative techniques into conversation with contemporary literature, specifically in terms of how we tell stories about illness. She is especially interested in writers who open up new ways of thinking about illness and health in their creative work.

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The Childfree Choice: An Interview with The Baby Matrix author Laura Carroll

MS: We appreciate your focus on teaching people to actually reflect on whether or not to have children rather than just do it because it’s what people do! In the The Baby Matrix you talk about getting people to actually assess whether or not they will make good parents and you discuss Ellen Peck and William Granzi’s The Parent Test which examines an individual’s aptitude for parenting. Did you take The Parent Test? What did it reveal to you?

Laura: While doing research for The Baby Matrix, I was delighted to discover Peck and Granzi’s book. I had not seen a book like this before. It was developed by a collection of experts, from Planned Parenthood leaders, doctors, ob/gyns, marriage and family counselors, sex educators, child psychiatrists and professors. Six detailed questionnaires go into “components of capability” for couples to ask themselves:

1) Expectations: What expectations do we have about parenthood? How realistic are they?

2) Resources: How do our resources measure up to the generally accepted requirements for the job of parenthood?

3) Skills: Do we have the needed skills for the job of parenthood? If not, how can they be developed?

4) Motivations: How strongly and for what reasons do we want to enter the process of parenting?

5) Traits: How well do we match the personal characteristics of happy, successful parents?

6) Interests: How sincere are our interests in all the elements of parenthood?

I completed all of the questionnaires, mostly to get a full sense of the assessment from a research standpoint. On a personal note, it confirmed what I have known since I was a teen – that I was not interested in having parenthood be the central focus of my adult life. Although this book was published some time ago (late 70s), I clearly saw how it remains very relevant today as a resource for making best decisions regarding parenthood. I have referred this book to many people in the midst of the parenthood decision and those feeling ambivalent, and it has helped them greatly.

MS: Now that there are websites such as Scary Mommy that expose the messiness of childbirth, parenting, etc. do you think that it’s still “taboo to talk about the negatives, such as the agonies that can be present at childbirth, the tragedy of death of the mother and/or the baby in childbirth or the drudgery and challenges of raising children” or have things changed when it comes to how we discuss parenthood?

Laura: What you quote from The Baby Matrix refers to early feminist Leta Hollingsworth’s 1916 paper about myths, or “social devices” that were needed to emphasize the positives of parenthood and encourage pregnancy. Talking about the negatives is less taboo now than in her time. Today we hear more about how many parents may not like a lot about the day-day-day process of parenting, but that the overall experience of parenthood is worth it.

There is one area that still seems less acceptable to talk about – regret. We may see more talk about this than in times past, but motherhood regret remains generally frowned upon. Why? Because pronatalist beliefs tell us that we are supposed to want to have children and experience it as the most fulfilling thing in our lives. When it turns out that this is not true, it is going against strong societal norms.

Israeli sociologist Orna Donath has done some interesting research in this area, and has a new book out based on it titled, Regretting Motherhood. An interesting thing happened when she began speaking to the media about it. In an interview I did with her she talks about how the debate about regretting motherhood shifts quickly to a debate about maternal ambivalence.

Donath has had to stress how they are not the same. In her words, “There are mothers who experience ambivalent feelings but do not regret becoming mothers, and there are mothers who regret becoming mothers and are not ambivalent about motherhood. In other words, regret does not deal with the question, ‘How can I become at ease with motherhood?’ but with the experience that ‘Becoming a mother was a mistake.’” Talking about ambivalence is easier – and more acceptable than candid admissions and experiences of regret.

MS: I see your book as feminist–you are working to normalize a woman’s decision not to have children. There’s also a powerful contingent of feminists, including Hillary Clinton, fighting for better paid maternity leave and affordable childcare.  In The Baby Matrix you note that one of the ways that our society is pronatalist is that fact that there are maternity and paternity leave policies. “While parents can take this time to care for their new baby, those with no children (yet or by choice) don’t get that time. All of these types of benefits favor and reward those who choose to reproduce, not those who do not.” What would this more equitable system like? How do you think both versions of feminism can co-exist?

Laura: To me, at its core, feminism is about equality and equal treatment. Maternity and paternity leave policies are inequitable because they favor one group of employees who have made a particular choice in their personal lives. This does not mean I am against leave policies where employees can take time off when a new baby arrives. I am all for it! Allowing new parents this time is a very important thing. But putting parenthood at the center of leave policies means not treating all employees equally.

This is why I am a proponent of PTO – or paid time off policies, where employees can use this time for a variety of purposes, one of which can be parental leave. The good news is we are seeing more PTO policies these days, and I hope that this continues to increase. Equitable leave policies don’t favor those who choose to make parenthood part of their personal lives, and don’t encourage any life choice or lifestyle in one’s personal life. Part of creating a work environment that treats employees equally also means creating a culture and policies in which there is no ‘punishment’ stemming from one’s reproductive choices, and this can relate to employees with children and without them.

MS: You had me nodding my head when you were talking about creating a curriculum that educates people to critically reflect on the decision to or not to have children, but when you started talking about revoking the rights of severely “unfit” individuals to have kids by requiring that they temporarily use long term birth control like an IUD (intrauterine device) for women or RISUG (totally “reversible inhibition of sperm under guidance”–two injections in the scrotum) for men, you started to lose me. This proposal makes me think of eugenics–the intentional cleansing of what are considered bad genes. Do you worry about the misuse of power in a system where people can have their right to reproduce revoked?

Laura: In The Baby Matrix I talk about the heavy prices society pays for subscribing to the idea that it’s everyone’s right to have children, regardless of whether people are emotionally, financially, or psychologically ready to have them. Too many children, the parents themselves, and society are harmed as a result of this unquestioned right.

Our society severely lacks ways to prevent severely unfit parents from harming children and society. In the spirit of igniting a discussion about ways to address these harms, in the book I broach this idea – What if those who show severe levels of unfitness as parents, such as recurring child alimony non-payment; physical, emotional, or sexual abuse; parental substance abuse; neglect; abandonment or homicide, could be required to temporarily lose their right to reproduce. Severely unfit mothers and fathers would not lose this right forever – but just until they are deemed out of the severely unfit classification.

The logic here is even in a democratic society like ours, rights are taken away when people harm others. We do this in our legal and prison system. The same could happen for severely unfit parents. I don’t see this idea as moving toward as eugenics, which is more about improving the genetic quality of the human population. And like all policies, it would need to be clear in its intent, which is not sterilization, but one that temporarily takes away a reproductive right as a punitive measure to deal with parents who have harmed or are harming their children.

In the book, which is written as more a manifesto, I present this idea as a way to spur further discourse on it as well as other ideas to solve this problem. One thing I do know is it’s a big problem that will need bold ideas to try and solve. I also contend that it will mean shifting from a pronatalist mindset that says anyone has the right to have children to one that treats parenthood more as a ‘privileged’ right.

MS: We appreciate how you unpack the argument that people should have kids so that said kids will take care of their parents when old age hits. You argue that people should plan for old age, not just financially, but also by creating networks. Can you talk about how you’ve prepared for “elderhood”?

Laura: Sure!

  1. My husband and I have long-term financial targets and are implementing our plan to get there for when we are old.
  2. We have and continue to build a support network of dear friends who are like family, godchildren, and other younger people we are close to in our lives.
  3. We have a home in a central location that will be close to health care services, community services and community-based networks. If we decide to change homes upon our elderhood years, this is will be a key component in the selection of our home’s location.

Also in play – dear girlfriends and I have started to seriously discuss how we want to live if/when we end up as widows. We seriously talk about living arrangements, from sharing a home to thinking bigger – developing a great business idea for the kind of elder developments and communities we’d love to see – even possibly create!

MS: You make a few arguments in The Baby Matrix that probably aggravate some people. For example, one argument against bringing more people into the world is that it is bad for our planet–it strains our already strained resources, so if people are going to choose to have kids, you argue, they should adopt or just have one. How have people you know who have more than one child reacted to this argument? Has it impacted any of your relationships with family or friends?

Laura: I put forth a ‘one or none’ biological child advice based on what many population experts encourage. If a person wants to raise more children, experts also advise taking children in need of loving homes. This not only means looking at the problems we have with our current adoption system, but how we as a society think about adoption. Society purports “bio is best” and that adoption is the “last resort” after all else fails. We’re at a point where we need to loosen our value on biological over adoptive children to do the right thing for the planet and those already on it.

When I think of those closest to me, either they have no children, one biological child, or two biological plus adopted children. For those who have more than one biological child, at the time they had them what was being touted more was ‘replacement’ – meaning a couple who each replaced themselves should have no more than two biological children. I would say they acted on what they knew at the time.

This was true for me as well; from reading the experts, for awhile I too thought two biological children per couple or less was best. Researching The Baby Matrix and subsequently serving as editor on the book on overpopulation, Man Swarm: How Overpopulation is Killing the Wild World really opened my eyes to how having one or no biological children is so important to population reduction and stabilization, which today’s world desperately needs.

For the most part my friends are very open to the issue. One friend (a mom) chose Man Swarm for her book club and invited me to come speak when they met to discuss it. The group was a collection of mothers and not, and we had a lively discussion about how to best educate today’s kids on reproductive ethics in a time when we are losing so much of the natural world as a result of too many humans.

MS: For your first book you interviewed couples who did not have children to educate people about happily married couples without children by choice. That book was published sixteen years ago. What kind of progress do you think we have made since the publication of Families of Two?  

Laura: I am pleased to say lots of progress has been made. Shortly after its release, being interviewed on network television to talk about Families of Two and that the segment treated the childfree in a curious and positive way was groundbreaking. It also sparked the topic being talked about more in print, radio and television media. At that time, the internet was very new. As it expanded, the childfree demographic really began to move out of the tributaries of society. Websites, blogs and online print media have fueled an explosion of information and education about opting out of parenthood. And in the last decade or so we’ve seen more research on people with no children than ever before.

I have also seen three positive trends. First, we have chipped away at some of the myths surrounding not having children. With some years of childfree voices hammering on inaccurate assumptions, we’ve nicked away at stubborn myths like those with no children by choice are selfish and that having children is “the” key to fulfillment in one’s adult life.

While there has been online pitting of parents against non-parents, we’re seeing less of it today. As cyberculture developed, it often promoted combative tones and oppositional communication, and when it comes to those violating the parenthood norm, this has been no exception. In the case of parents and non-parents, this kind of online communication has only served to judge and separate both camps. These days online there seems to be less adversarial banter and judging of others’ reproductive choices, and more about mutual understanding of both camps.

Overall, from tracking it for the last 16 years, I see the childfree choice gaining more levels of acceptance with each generation. I am dedicated to reaching a time when the choice not to reproduce is recognized as just as worthy and legitimate as the choice to reproduce. It is a matter of reproductive justice, and society reaching full reproductive freedom. We’re not there yet, but as of 2016, we’ve certainly notched closer to this end.

Laura Carroll is the author of Families of Two: Interviews with Happily Married Couples without Children by Choice, which received international recognition and paved the way for her to become an expert and leading voice on the childfree choice. For the last 16 years, she has tracked and researched the childfree. Laura is also the author of The Baby Matrix: Why Freeing Our Minds from Outmoded Thinking About Parenthood & Reproduction Will Create a Better World.

In addition to writing nonfiction, Laura is a seasoned editor and communications consultant. She has been featured on ABC’s Good Morning America, CBS morning shows, a variety of radio talk shows, U.S. and Canadian public radio, print/digital media, including Fortune, The Wall Street Journal and New York Magazine to discuss social science topics. Find Laura at

It’s a Boy!: An Interview with Katy, Part 3

This is the third interview in a series with Katy, a 42 year-old creative director who at 35 decided to freeze her eggs and at 42 decided to go ahead with a donor. Read Part 1 here and Part 2 here. This interview reveals Katy’s good news!

MS: Last I talked to you, you were about to find out if you were pregnant, are you?

Katy: Yes! And it’s a boy!

MS: How do you feel about being pregnant?

Katy: I’m excited. When I first found out I was pregnant I was so stunned, grateful and excited. I felt so lucky that I got pregnant on the first try. Granted I went through IVF and had acupuncture treatments which greatly increases the odds… but still I felt incredibly lucky. It made me feel like I chose the right path.

I also felt terrified at times too, particularly in the first trimester… it was hard to let go of the safety of my single, child-free life as I have known it. It’s a major life change into the unknown and it made me feel uneasy and vulnerable at times. But reading books about parenting has helped me become more confident, which then makes me excited. Plus, when I’m around kids they fuel my excitement and then I feel like “I’ve got this.”

As far as how pregnancy feels in my body, I really enjoy feeling him kick, seeing the ultrasounds, the porn-star breasts and eating all the time… then there are other sensations and bodily changes that come along with pregnancy that aren’t so pleasant. But when I read about what’s happening each week in the baby’s development, it always amazes me and I’m reminded of what a gift it is to be pregnant.

MS: What are you excited about? What are you nervous about?

Katy: I’m excited to meet him and get to know him. I’m excited that this chapter of my life is starting: motherhood. I’m excited that I’m not on the sidelines anymore just watching others fulfill their dreams; I’m now jumping in and fulfilling my own dreams. But there are also so many unknowns that get me nervous. Will he be healthy? Will we bond? What kind of a monster will I turn into when I am sleep deprived? Will I have postpartum depression? Will he resent me because he doesn’t have a father?

MS: Before you were worried about finances and not meeting someone — what are your primary concerns now?

Katy: I’m still worried about those things, but I have focused less on when I’m going to find my partner. I think my larger concerns right now are how am I going to pull this off and still maintain my sanity… being a full time mom, working full time and getting enough sleep. I’m going to need help, so I’m sorting out where I will get this help from.

MS: You spent a good deal of time deliberating over this decision. Now that you are pregnant, how do you feel when you look back over those deliberations?

Katy: This was a major decision and I needed time to process it. But I wish I had started this process sooner. Sometimes I feel ambitious and think “maybe I’ll have another child” since I have more embryos, but my age may be an issue (I’m 42 now). It would have been nice if I was a few years younger, so I could have more flexibility with that decision in the coming years.

MS: Do people assume you have a partner or ask stupid questions about how you conceived?

Katy: Thankfully no. Maybe they assume that I got knocked up unexpectedly. But no one has asked me anything about my “husband” or how I got pregnant. When I tell people that I used a donor, they always respond with excitement and curiosity. They want to know all about the whole process. This has been a nice surprise. I spent too much time caring about people’s reactions before I got pregnant.

MS: Do you have any advice for someone considering freezing their eggs? Using a donor? Choosing to be a choice mom?

Katy: Freezing eggs: this is a no brainer for me, as you have nothing to lose… provided you can financially afford it. Just know that it can be hard on your body, and some people react strongly to the hormones.

Using a donor and deciding to become a single mom by choice: this is clearly a larger decision to make, and it needs some thoughtful consideration. There is no wrong or right decision here; it’s more about what choices can you live with. Do your research, check out Single Moms By Choice , read up on donor-conceived children , check out sperm banks (cryobanks) to learn about donors, read up on adoption processes, talk with women who have adopted, women who have used a donor and women who have decided not to have a child on their own…. decide which route is best for you. If you are considering a donor you know, meet with a lawyer to get the facts. And sometimes your finances or your health might dictate which route is best for you. The point is, there is a lot to consider… and you want to feel good about your choice. So research is key. Good luck!

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“Baby now, partner later. Not one or the other.” Interview with Katy, Part II

This is the second interview in a series with Katy, a 42 year-old creative director who at 35 decided to freeze her eggs. Read Part 1 here. This interview focuses on her desire for a relationship and her fear of being a single mother with a baby will prevent her from finding a partner.

MS: Did freezing your eggs make dating easier? Was it a kind of an insurance policy?   

Katy: I think it did help for a while, but I always had in the back of my mind that I might not have enough frozen eggs to get pregnant with, since the doctors said I might just get one embryo from my frozen eggs. I was always thinking about it. But I thought at least I have a backup plan and if that doesn’t work, I’ll adopt. I accepted the fact that I might have just one chance with my frozen eggs, but it didn’t allow me to totally relax. I was really surprised when it came time to fertilize my eggs that I actually got six embryos out of seven eggs. That was an amazing return!

MS: Congratulations!

Katy: Thank you. That was absolutely astounding!

MS: What concerns do you have about doing this by yourself?

Katy: Oh my god. I have a long list.

I worry about not having enough help, not being able to get enough breaks and being sleep deprived on top of that.

I’m worried about finances. I wonder about, what if I want to change my career in the future? Would I be locked into a certain financial bracket that limits my career options?

I’m also very worried about how I’m going to meet someone to partner up with and finding the time and energy to date. How do you balance that? Divorced parents have every other weekend where they can spend a whole weekend with their significant other, and I’m not going to have that and that really, really concerns me. That’s my number one concern with this decision. It’s very important to me that I find my life partner. Some women who choose to be single moms by choice are choosing to have a baby over a partner. For me, I’m not giving up on having a partner in order to have a baby. I want both. I can have both. I deserve both.

But I only have this time now to have a baby. For me, it’s baby now, partner later. Not one or the other. But how much later is that? And how many quality single guys are going to be out there?

The idea of never finding a partner really scares me for the loneliness factor. I think a baby will fill a portion of that need, but certainly a baby won’t replace my need for a partner. I want to have a family unit, beyond me and my child. It bothers me that I don’t have that. At least right now I don’t. I know there are advantages to doing this as a single parent. I don’t have to argue with anyone. I don’t have to worry about getting a divorce and fighting for custody. But I really had hoped that I was going to be doing this with a partner which is why I waited so long. It was really, really hard for me to let go of the dream. I don’t know that I have let go of it completely. I’m just re-imaging a different kind of family dream now.

Now that I’m actively trying to get pregnant I don’t want to meet someone because I don’t want them to stop me from having a baby. Even though I’m lonely and I want the company, I know myself. I know I can get all starry eyed on one date, and I don’t want another guy to make me postpone this anymore. Say this IVF cycle doesn’t work, and I have to go through it again, I don’t want this guy to cause me to postpone that next cycle. It’s just emotionally confusing to date while trying to get pregnant with donor sperm.

MS: You have a no dating policy right now?

Well, if a reliable source were to set me up I’d go on a date, but I’m not looking. I feel like I’ve had several relationships that have held me up from having a baby, and I don’t want to make that mistake again.

For a while there, I wondered would I enjoy a child as much as I would if I were in a relationship. I worried I wouldn’t feel as much joy. I know the source of this worry was because I was feeling lonely and a little depressed and it was hard for me to imagine feeling that joy.

I don’t feel that way now. Once they thawed my eggs, fertilized them, and I got such an amazing return (six out of seven fertilized), there was something that shifted in me. I felt like this isn’t just good luck. It made me feel like I chose the right path. Maybe that’s naive, but I can’t help but feel like I made the right choice.

MS: Have you been telling people that you are going through this process and what are the reactions?

Katy:   I have told way too many people! I know they say not to tell people in case you have a miscarriage, but I needed a support network. I told a lot of people: neighbors, friends, some extended family, of course all of my immediate family. Everyone was so supportive, even the people who I was worried wouldn’t be supportive.

Another big concern I have is that my child won’t have a dad.  I worry about my child resenting me for bringing them into the world without a father. I have felt guilty about this but I think I’ve gotten past my guilt for the most part. It’s something I wished for my child, but that’s not happening now.

When I told a male coworker that my child would have three uncles as male role models, he said, “I’m glad to hear you say that,” because he wonders if women who pursue motherhood using a donor feel like a dad isn’t necessary. Maybe there are women who feel that way, but personally I had an awesome dad. I’m so grateful for that, and I’m sad that my child won’t have that relationship. My Dad was just amazing. By no means do I feel like a dad isn’t important. It’s just there isn’t one in the picture.

Having three uncles for my child makes me more comfortable. If my child ever got upset with me I would tell them I couldn’t imagine life without them, and I had to do it even though it wasn’t the perfect family unit.

MS: So you find out in two days whether or not you are pregnant. How does that feel?

Katy: It’s super exciting. I’m very excited. It’s crazy to think how this news will change my life. I found myself last night for the first time starting to think… what steps are next?, assuming that I find out I am pregnant. Then that thought induced some anxiety… the overwhelmingness of it all. There are things I need to work out, such as my job situation. I don’t have a full-time, salaried job, I have full-time contract work. I plan to work up until maternity leave, but I don’t know if I have a guaranteed job to come back to. I would like to stay in my house but I might need my mom’s help, and my house is too small for her to stay with me. So should I move in with her temporarily and rent out my house? These are things that give me anxiety.

MS: At every step this process was more complicated than you expected, more painful physically and emotionally than you expected. You are 42 now, what would you tell your 34 year self to do?

Katy: I would tell myself to do exactly what I did: harvest the eggs. I think I made a good call not to harvest more because it was hard on my body, but I would have told myself to start this process earlier. I would have told myself to research single parenting and donors even before I was ready to dive in. Just research the details of the whole process, mull it over at my leisure without feeling like I had to rush and process things at the same time. Not every woman feels the need to process emotions like I did. A lot of women jump right into it and have no problem so that was something that took me by surprise.

MS: You know a lot of women who are doing this. Do you think that made it easier for you to do it?

Katy: Yes, I have a close friend who did this, so luckily I got to witness her entire process years before I embarked upon my own. Also I reached out to the community of Single Mothers By Choice, but after I was deep into the fertility process. I had two previous IVF attempts and canceled them both because I had doubts. It would have been helpful to have known this group of women before I jumped in. Reaching out to this group helped quite a bit because everyone had different experiences to share, and it became less lonely to me to have a child as a single mom. It felt empowering in a way, like there’s a movement. All of these women are so brave and so vulnerable, they were so afraid and just did it anyway. It was really encouraging to hear a lot of them say, “Oh, I completely doubted myself. I wasn’t sure but I did it anyways.” They were there for every step of the way. Of course, once I started telling people that I was doing this, they started connecting me with other women they knew who had become single moms by choice.

MS: So, on Wednesday you find out if you are pregnant?

Katy: Yes, I go in for blood work and they will call me later to tell me the news. I want your readers to know that I was not sure about my decision before moving forward, but it was something I kept coming back to: I just have to do this or I’ll regret it if I don’t.

MS: What pushed you to just go for it?

Katy: In the spring, I considered not doing it but something kept bringing me back, and I would think, there’s no way I’m not doing this. But I couldn’t retain that “sure” feeling all the time. I was still really nervous. I would have days when I was gung ho and days when I didn’t know what I was doing. I averaged a freak out a week. At one point I just made the call to go for it, despite the fear and doubts.

I know this sounds strange, but once I made the call to thaw and fertilize my eggs with donor sperm, I kind of surrendered.

The whole thing is nerve wracking. Something I think that’s been helpful is reaching out to people often and regularly. Talking to people about what I’m going through has been helpful.

MS: Can we talk to you again after you find out if you are pregnant?

Katy: Yes!

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Choosing a Donor: An Interview with Katy, Part I.

Katy, a creative director from Atlanta, froze her eggs at 35 and started reviewing sperm donors at 41. At 42, after agonizing over the decision for a few years she decided she was ready to become a single mother by choice. Katy has agreed to be interviewed throughout this process.

MS: Was 35 the magic number for you?

Katy: Yes, because the doctors all said that 35 is the year when your fertility drops off significantly.

MS: Why did you decide to freeze them?  

Katy: I read a magazine article about egg freezing in my early thirties, and it stuck in my head. I don’t even know why I was thinking about that at the time. I knew I wanted kids, but I wasn’t worried about it happening. I was having fun and wasn’t in a hurry to become a parent. I remember around 34 my biological clock kicked in like a switch. The term really makes sense to me now. So, at 35 when my relationship didn’t work out I decided, okay, I’m going to freeze my eggs and buy some time. So I researched different fertility clinics in Atlanta and found the best one and went for it. Luckily my insurance at the time covered one round completely.

My doctors recommended doing more than one round because I didn’t have enough eggs. They collected eight eggs and one didn’t make it, and they said you need six to have one good embryo, and often it takes multiple attempts to get pregnant. They were hoping I would have 18 eggs. So I tried a second round and my body didn’t respond at all, which was worrying, so they told me to take a break and try again in six months.

I didn’t want to do it again. It’s really hard on your body. You have to take daily hormone injections that stimulate your follicles to be able to drop multiple eggs. I remember having to go to the doctor’s office every other day to check my hormone levels. Once they see you are at a certain level, they give you a trigger shot that tells your body to release all the eggs at one time. It takes about 36 hours for that to happen, so 36 hours later you are in the operating room, and they are scooping up the eggs. You go under general anesthesia, they go through your cervix with an instrument like a straw that scoops them up. You are crampy for a day. That wasn’t a big deal, but I definitely noticed that after I got off the drugs I had withdrawal symptoms and was very teary and emotional for months, which was why I didn’t do it again.

MS: Did you have reservations about freezing eggs in first place?

Katy: I didn’t. It was covered financially. I would have a backup fertility plan. I didn’t have to commit to anything at that point in time. It seemed like a win-win.

MS: When did you decide you wanted to go ahead with fertilizing your frozen eggs?  

Katy: It happened in stages.

I was dating this guy when I was 39 and he didn’t want kids, but I was hoping he would change his mind, and he was hoping I would change mine but neither one of us budged. We broke up because of this. That was the spring before I turned 40.  At that point I decided to go ahead and have a baby on my own.  Meanwhile I had not researched what was involved.  I didn’t know about the Pandora’s box of the donor realm. I thought, I will just buy some sperm and that’ll be it. I totally underestimated that.

That spring I had an exam to ensure my uterus was in good shape for conception and low and behold I had a polyp on my uterus, so I had to have it removed surgically because it would prevent an embryo from implanting.

Around that time, I went under contract on a house. Then I lost my job at the same time and found myself with a new house and no full-time job, so I wasn’t wanting to jump on the baby thing right away, and I didn’t want to give up the idea of having a baby with someone I love. So, I decided to date online for six months and see if I met anyone and if not, then I’d do it. It felt lonely, the idea of having a baby alone.

So when I started dating a new guy in the winter, I told myself I won’t think about the baby thing for a while. He said in the beginning that he wanted another kid (he already had a daughter), so I relaxed.

Fast forward several months, I turned 41 and really start feeling the pinch. So I ended up having a conversation with my boyfriend in September where I told him that I was feeling that biological clock pressure, yet I didn’t feel like we were at a point where we could make a commitment to each other. He agreed. He also told me at this point, “I’m not ready to have another kid.” Then he said, “Why don’t you just go ahead and have a baby using donor sperm since you were considering it before you met me. Then we can continue dating and see if things are right between us and if they are I can become the step-father of your child, if not we’ll go our separate ways.”

For some reason, that made sense to me at the time. It was like a green light to get pregnant!  It was comforting to be in a relationship and move forward with having a baby, rather than doing it entirely on my own. I just dove forward, I was over the moon excited about it. It was the first time, where I felt this real desire to go for it. Of course, I had his companionship all the time, so I didn’t feel lonely, but shortly after that conversation we started growing apart and ended up splitting up.

MS: How did you choose a donor?

Katy: I had a lot of trouble selecting a donor. I didn’t realize there was so much involved. It was not as simple as I expected.

There are known and unknown donors. Known is just how it sounds. You’ve met the donor, he could be your best friend or introduced to you through someone you know. One day someone suggested to me, “You always speak highly of your male friends, would one of them be willing to be a donor?” At first I thought absolutely not, but then I started thinking about it and became interested in the idea. On one hand, I could imagine a harmonious parenting scenario, but I knew they didn’t want kids. I decided not to ask them, just to process it. Then I met with a lawyer about the ramifications of using a known donor. She said if you have a child with a known donor and that child never sees the donor until adulthood, you can be pretty much be guaranteed that the donor can’t claim custody of your child. Also this route is very expensive, you have to go to court several times to tidy up paperwork. But if the donor sees your child, it opens the door for the donor to get custody of your child. As much as I would like to believe that would never happen with my friends, everyone I talked to had stories about harmonious situations like this, until the donor becomes really interested all of a sudden, wants custody of the child and it becomes a mess. I thought, oh my god, that sounds like a bad idea. So in the end I never talked to my friends about it, I went forward with an unknown donor. I feel good about my choice.

An unknown donor is through a cryobank. The benefits of an unknown donor are that they are pre-screened for HIV/STD’s, their entire family medical history, genetic diseases… information you might never know about your spouse. They have profiles set up, which is a lot like online dating, they list information such as their eye and hair color, height, weight, race, blood type, interests, occupation, education, social tendencies, family dynamics, etc. You can listen to an interview where they answer pointed questions about themselves, and most of them provide pictures. The information you get is pretty detailed. And, you know with an unknown donor that your child is legally yours. There’s no threat of the donor claiming custody of your child.

There are anonymous unknown donors and “willing to be known” unknown donors. Anonymous means your child will never meet or be able to make contact with the donor. Willing to be known means when your child is 18 the cryobank will set up an arrangement between your child and the donor. It can be a personal meeting, a phone call, or an email depending on the donor’s choice. They guarantee one meeting and then it’s up to your child and the donor beyond that. That was without a doubt a “must have” for me. I think it’s so important for my child to have contact with the donor. Of course, children are going to be curious about the biological father who’s not in their life, especially in their teenage years, and I want to grant my child the right to contact him. This led me to look for a compassionate donor. I was really looking for clues into his character. I wanted some assurance that he’s not going to bail out years down the road and go MIA.

MS: What concerns did you have about using a sperm donor?

Katy: I didn’t realize how hard it would be for me to accept emotionally. For a while there I was having an issue with the whole idea of a stranger’s sperm mixed with my own eggs and inserted into my body. I would be having a baby with someone I’ve never met!

That was really hard to accept. I changed my donor twice. I kept having little issues with the first two donors. It seemed like nitpicky stuff, but I think part of it was my process of getting comfortable with using a donor.  The first time I selected a donor, I was not ready yet. I started my IVF cycle before I had even picked out a donor, which is not a good idea. I didn’t realize how much there was to process emotionally. Ultimately I had to accept my circumstances. Okay, I thought, these are my choices: I can use a sperm donor, I can adopt or take my chances that a relationship will work out where we have children together. I finally reached a point where I felt like I not only needed to move on it but I was ready to.

I learned over time that I had to reframe how I thought of this donor, so that I could feel comfortable with it because I knew in my heart it was important to me to have a genetic child. If I couldn’t have a genetic child I would happily adopt or foster, but I had those frozen eggs waiting for me giving me the chance for a genetic child.

I was also focused on finding a cryobank with a low family limit. When you use a donor through a cryobank they have limits on how many families they sell one donor’s sperm to. The average U.S. limit is 25 families which could easily mean 50 kids per donor, sometimes more. And there’s no great monitoring system in the U.S. The scary part about using an unknown donor is not knowing how many half siblings exist and wanting to make sure your child won’t become romantically involved with a half sibling one day.

There is a network called the Donor Sibling Registry. They set up an international registry for donor-conceived kids to connect with other kids conceived by the same donor. The parents can find out about any genetic health problems other half siblings may have. It’s also a good way to see how many other half siblings are out there and where they live. A lot of these extended families are getting together and having their own family reunions. When I was first reading about this, I was thinking, there’s something kind of cool about this… these extended families.

MS: What characteristics did you look for in selecting a donor?

Katy: Someone who has a clean medical record, no history of cancer in his family, is well educated, seems like a warm-hearted good person, has a similar ancestral background to mine and is attractive. And these are all qualities that my current donor has.

The first donor I picked out looked like my ex-boyfriend, and initially I liked that. But I ultimately became worried about looking at my child and seeing my ex-boyfriend in his face, so that was one reason I changed to a new donor.

Ideally, I wanted someone who was not just doing this for the money but also wanted to help people conceive. Of course, money is what drives someone to do this so that was hard to find. These guys are mostly college students, my guy was a law school student. He was an accountant preparing for the bar when he donated.

His spirit was the thing that made him stand out against the others. He sounded like someone I would naturally be attracted to.

He was also compassionate. He spent a summer in Costa Rica saving sea turtle eggs. I got to witness sea turtles laying eggs when I was in Costa Rica, and it’s really magical. There’s this whole thing about sea turtles returning to the beach where they were born to lay their own eggs. My point is something that seemed magical to me was important to him, so that drew me to him.

I was left with a good feeling about him, I stopped questioning what I was doing and felt comfortable using his donated sperm.

From Certain to Ambivalent back to Certain: An Interview with Liz

An elementary school teacher and part-time unit coordinator in a birthing unit, Liz is 38 and 14 weeks pregnant at the time of the interview. Liz immigrated to the U.S. from England when she was six and she became a U.S. citizen at the age of 36.

MS: Have you always known you wanted kids?

Liz: I always knew that I wanted kids and then I started to doubt that I wanted kids. I always wanted kids. When I was six someone asked me what I wanted to do for a living and I said that I wanted to be a mom.  But then, years went by and I was single and I think I was pretty depressed about being single and then

around 30 I was like, maybe I just won’t be a mom and that’ll be fine.

And all of my friends were having kids and whenever I hung out with them it felt very overwhelming and I thought, oh maybe not, maybe I don’t want that.

MS: So you went from certain to ambivalent and then you met Jeff?

We had been dating maybe a month, and he said one morning, do you want kids and I said, yeah. And that sort of surprised me too. And I said, does that make you nervous? And he said, yeah.  But it was my gut response.

Liz: When you were younger you envisioned yourself having kids, when did you think you would start?

Probably my mid-twenties. My mother had her kids when she was 24, 26, 30 and then I started to be those ages and I thought, I could not have a kid. Even if I had been in a relationship, I don’t feel like I was capable of having a kid at that point.

MS: What do you think is different?

Liz: My mom met my dad when she was 15. It’s just generationally different. They got married and had kids. And, I think that because of the internet and travel being cheaper, we have a million other things to do, whereas marrying young doesn’t happen as much.

MS: Do you think there are any drawbacks to waiting until you are over 35 to have kids?

I think the drawbacks to having kids later probably measure out to the same as having them earlier. You have less time with them more than likely. My kids will have less time with me than I have with my parents.

Hopefully, I’ll be a more patient and better parent than I would have been ten years ago.

I think I have more empathy than I used to. As a teacher, I am more able to put myself in another parents’ shoes and look for the best in kids rather than just reacting to them.

MS: How has teaching impacted your perception of parenting?

Liz: I think that teaching and seeing so many parents and families makes me realize that for 95% of people everyone is trying to do what’s best for their kids. I can’t always figure out how that works in their minds.

MS: Do you think your age has affected your pregnancy in any way?

Liz: I doesn’t seem to have. I’ve been to the maternal-fetal medicine specialist because my mom had problems and because I am advanced maternal age, and they said, everything looks really good. I can’t complain about anything in my pregnancy except for the nerves. I haven’t felt sick; I haven’t thrown up. I feel fine.

MS: What is making you feel nervous?

Liz: I know that this baby needs another ten weeks of gestation. It’s just that unknown. Every ache pain, cramp, everything I put in my mouth, can I eat that, can I not?

MS: Do you think you would’ve been as nervous if you were younger?

Liz: Yes. All my lab results are good. I just think until this child comes out and both of us are responsible for it, I’m the only one responsible for it. I wanted a sip of wine the other day and our doctor said no, and I said to him, it’s not about the alcohol, it’s about feeling normal. I feel fine, but I never feel normal anymore because every single thing I put in my body, every action I do, I think about this baby.

MS: Do you think that’s healthy?

Liz: No. I do think that because the American College of Gynecologists wants to cover their asses they are doing a lot of telling you you can’t have certain things so I then look up, well does Europe do that? If Europe and America agree, then I won’t eat it, but smoked salmon, England eats, so I’m going for it.

MS: How has working in a birthing unit impacted your perception of pregnancy and delivery?

Liz: I switched to a midwife recently and I was talking to the nurse when making the appointments and she said I had to have a doctor to go along with my midwife and she said this particular doctor is very blunt and then this other doctor will talk to you for hours. And I said, who has the lowest C-section rate? That was my deciding factor because, when a woman has been in labor for hours and the red sox game is coming on, I’ve seen doctors make the call to do a C-section.

MS: If you could give your 25 year old self advice about pregnancy and motherhood, what would you say?

Liz: Vanity speaking, I now show and most people at 14 weeks don’t show. I read that because my core was not solidly in shape, that there’s no muscles holding in my uterus. I would tell myself to be in good shape. The better shape you are in, the better your recovery will be.

MS: Sometimes there’s friction between mothers and non-mothers, have you ever experienced this tension?

Liz: So many of my friends have kids and I always tried to be very understanding. I always really liked babies and I would go over and help out. I think I had a hard time when I was a non-mom not by choice. I had a particular friend who, it was right around when my dad died, and she found out that she was having a second boy and she told me about the “grief” she was experiencing, from this planned, health pregnancy!–because she was having a boy instead of a girl, and I had a really hard time forgiving that. She and I had talked very openly about how much I did want kids and it wasn’t in the cards. So for her to use the word grief, I was so taken aback.

MS: Do you think it’s a trend of moms to be insensitive to nonmoms?

Liz: I was just at a cocktail party with a woman who told me she was trying to get pregnant and had done six rounds of IVF, and everyone who came into our conversation and just found out I was pregnant would try to talk about it, and I would try to steer the conversation to anything else.  I was not feeling guilty but feeling this poor woman does not need to hear about all of these things when she is going through this.

MS: Do you think being pregnant at an advanced maternal age helped you develop the sensitivity to steer the conversation that way?

Liz: Yes, knowing the feeling of longing to have kids and not being in a position to have them. Those conversations are not where you want to be. I didn’t always want to hear the pregnancy talk from my friends with their big bellies, but I listened.

If Not Kids, then Something Substantial: Interview with Melissa

Melissa is a 42-year-old middle-school math teacher with two dogs. She regularly takes her husky, Takoda, to a youth detention center to provide pet therapy, and she spends her summers traveling.

MS: Do you want kids?

Melissa: So, I never say “no,” but I guess I never say “yes, definitely.”  I always thought that I would.

I never thought, “I’m never going to have kids” until recently. I said it out loud for the first time the other day to my friend.  I was surprised that it came out so naturally.

I just had a birthday, and you hear all the time that after a certain age, don’t even think about it. Even if I met someone tomorrow, having kids would still be years off.

MS: What do you think made you say it out loud? Do you think it was turning 42?

Melissa: I don’t know if it was the age or the thought that I’m never meeting anyone. Never. Ever.

MS: Can you separate having kids from meeting someone?


I thought about having one on my own, but I just think my life would change too much, and I don’t know if I have the support system for it.

So much of my time is spent making money, and I would have to give that up plus put money in. Kids cost a lot when you don’t have a built in baby sitter.

MS: You have a lot of time to meet someone. Do you feel like you are not going to meet anyone because you are past childbearing years?

Melissa: I think when I meet people casually, as soon as they find out how old I am, it changes their point of view. There are men who have an idea what a good age is for a mate, whether they want kids or not. That’s my experience.

Men don’t have to worry about running out of time.

The other thing is: I don’t feel like I can’t have a baby.  I don’t feel like my body is old. I feel healthy and young. But my body inside could tell me something totally different.

MS: What about when you see celebrities having children in their late forties?

Melissa: Then, I think, “Oh, maybe I can.”

MS: Would you consider adoption?

Melissa: I’ve thought about fostering. So much would have to change. I don’t think my brain has fully wrapped around time for me to rush into doing anything.

MS:  Do you think you could be happy if you met someone and didn’t have kids?

Melissa: Yeah, I definitely think so. That’s the only time I get upset. I just teared up a little bit. What if I do meet someone, and he really wants kids and it can’t happen. Or, if I really want kids because I love the person that much.

MS: When you were little did you envision yourself having kids?

Melissa: Yes, I’ve always said. “when I have kids…”

MS: If you fell in love with a guy who didn’t want kids, would you pursue a relationship with him?

Melissa: If he told me right off the bat, I would still date him. And if I fell in love with him, and he said let’s go travel all the time, that would be fine with me. I would need something of substance to take that space other than the normal get up have breakfast, go to work, then have dinner.

I would need something to take the place of kids.

We could buy a bigger house with a lot of land to foster dogs. Do something more giving. I foster dogs. Not only do I have my own two dogs, but I hold dogs and take care of them until they can be adopted. That would fill that need.

MS: What do you think are the advantages of not having kids?

Melissa: I can do anything, for the most part. I have to make sure someone can come and let my dogs out. So, I can’ be totally spontaneous.

Little things: my house doesn’t have to be spotless all the time. I can nap in the middle of the day. I napped yesterday, and I thought, so many people can’t do this because they have kids. I don’t have to think about being frivolous with my money. I can spend it on whatever I want to. I suppose these are little things compared to being a mom.

But, sometimes I listen to the radio in the morning and all the people do is complain about their kids. I see the misery that my parents went through, and I don’t know. I know there are so many good things, but there’s so much sacrifice. And you’re glad to do it once you become a mother, or at least you do it.

My friend has fertility issues, and she was at a party and a woman with three kids turned to her and said, “you are so lucky you don’t have kids.” My friend said to me when she was telling me the story: “lucky” is when you have a healthy child. If you don’t have kids, you either chose not to or you are unlucky.

MS: If you could tell moms how to be more sensitive and kind to people who are not moms, what would you tell us?

Melissa: Being a mother requires sacrifice but for most people who are mothers it’s something they chose to do. Don’t judge me because I didn’t follow the same path as you.

MS: Has anyone said anything insensitive?

Melissa: If people ask if I have kids when they meet me and I say “no,” they respond “Oh” and say something to the effect of: “What do you do with your time then? What makes your life important?”

I also hear it from my students, “Oh, you don’t have kids. Oh. Really?” I say, “no, I have fur babies.”

melissa's dogsMS: Do you feel like having dogs scratches the mom itch at all?

Melissa: A little bit. I have to nurture them. I have to make sure they are good dogs for their society. But I can leave them home for hours without someone taking care of them. When I’m working I have to make sure someone comes and walks them and lets them out. And the financial part of taking care of dogs is a fraction of taking care of kids but it is still vets and good food. When my dog had one little rash, we were in for hundreds of dollars. I guess I get worried and nervous. They are like babies because they can’t take care of themselves. So it helps it a little bit.

MS: What about teaching?

Melissa: Teaching makes me understand why I’m okay not having kids.

MS: Are there things you’d have to give up if you had kids that you’d be sad to give up?

Melissa: Well, I go out all the time. But, then I ask myself: if I had a significant other, would I want to stay out so late?

MS: If you could give your 22-year-old self a message what would it be?

Melissa: I’ve had so many relationships that I didn’t fully commit to thinking there’s something better, and  I don’t think I ever let myself see if the relationship was working. I would tell myself to be more open minded and give the relationship a chance to work.

MS: If you could give advice to a 30-year-old woman who didn’t know if she wanted kids, what would you say?

Melissa: I would advise someone to not have kids just because society tells them to. That’s the wrong reason. You need to do it because you want to and because you think you’ll be able to give the best life possible. I see it all the time: house, marriage, kids. Sometimes I don’t think people actually sit back and think, maybe we don’t want kids, and if we don’t it’s okay.

I never made up my mind either way.

A Doula’s Wisdom: Interview with Sarah Thayer

From the Editors: We recently interviewed Sarah Thayer, a certified and trained birth doula who is now a nursing student with plans to become a nurse midwife. With eleven years experience working with pregnant and laboring women, she offers us an observer’s perspective on pregnancy over 35. 

MS: Can you describe your role as a women’s health care professional?

Sarah: I worked as a certified and trained birth doula from 2003 until 2014. I am also a licensed massage therapist and have been licensed in the state of Connecticut since 2004. In my massage practice I see both men and women but have specialized training in pregnancy massage. I have an undergraduate degree from Central Connecticut State University in sociology. I am a nursing student at Capital Community College in Hartford, CT and will graduate with an associates degree in nursing in 2017. Upon receiving my RN license, I intend to continue to graduate school to become a nurse midwife with a clinical doctorate degree.

As a birth doula I worked with women and their families to help them have their own best birth experience. Birth doula’s do not provide clinical care, but rather help their clients during pregnancy, labor, birth, and the immediate postpartum to have a positive birth experience. This is different for every woman and family. This element made my job endlessly interesting.

Primarily I listen to women. I try to understand how I can best support each mother and family in a way that empowers her to make her own best choices. Because I am familiar with the policies of hospitals and different medical practices, I can give referrals, when asked, to providers and facilities that may be a good match for the goals of an expectant mother. There isn’t a wrong way to have a baby, but knowing all of your options and picking the provider and place to birth that is in alignment with your goals is the first step to a positive birth experience.

The over all arc of my work with families includes informational support in pregnancy, connecting women and families to community resources, 24/7 on call availability from 37 weeks of pregnancy through birth, continuous labor support with guaranteed back up doula support in the event of emergency or illness, immediate postpartum support, and a postpartum follow up visit in the first 6 weeks after the birth.

MS: From our perspective, there seems to be some fear mongering when it comes to tests,for women having geriatric pregnancies. Can you share your perspective on that?

Sarah: We have the ability to know more about fetal development because of new genetic tests and advances in technology. I think it can be difficult for patients to navigate understanding what the tests are, what the purpose of them is, what the results mean and don’t mean, and if they have to undergo all the screenings that they are sent for. For example, some screenings simply say that there may be an abnormality that may indicate that further testing is needed to see if there is, in fact, something not developing normally. Further testing could reveal everything is progressing perfectly fine, but more invasive tests, like amniocentesis, come with risks of their own like infection or miscarriage.  It can be a roller coaster for women who feel anxious and frightened while waiting for results when, in fact, everything is fine.

It is true that there is a higher increase in fetal genetic abnormalities when a mother is over 35. It is also true that there are higher risks of miscarriage and other complications when a mother is over 35. I think that women need to soul search a little bit and make informed decisions about the purpose of testing. Is there a family history of congenital abnormalities that warrants exploration? Does the mother have a history of recurrent miscarriage that would indicate genetic testing? Is the woman thinking she may end a pregnancy that has markers of genetic abnormalities, or is that not a choice that she is considering? Is this a woman that finds comfort in more information rather than less? I think one of the problems is that the medical system doesn’t always do a great job of educating patients about which tests are mandatory and which tests are optional and what the pros/cons of a test are. In general, the medical establishment functions in a “More is Better”, mentality without the shared decision making between patients and providers which would empower patients to decide which tests are most valuable to this woman in this pregnancy. Again, this is where provider choice is extremely important. Pregnant women should never hesitate to leave a practice where she doesn’t feel listened to or where she isn’t given informed consent of every test or procedure that is entered into.

I think pregnancy can feel so overwhelming that women forget that they can ask questions or change providers at any time. Women should learn to ask “what is the benefit of x, what is the risk of x”? and “is there any reason why I can not do x?”.

MS: If a woman is deciding /trying to get pregnant for the first time over 35, what health-related considerations do you advise?

Sarah: In my present roles as doula, massage therapist, and nursing student I am unable to give medical or health related advice. That said, my best non medical advice is to think about the type of care you want to receive, how you want to experience pregnancy, what kind of birth experience you think you want. Ask other women about their doctor and midwife recommendations. Women generally like to share their birth stories, so ask them! What did they like about a doctor, midwife, or hospital/birthcenter/home birth experience? Midwifery care is different from OB care. Hospitals that look very similar from the outside may have vastly different policies on the inside that impact patient satisfaction and health outcomes for mother and baby.

Living an active, healthy and balanced life is a great way to start a pregnancy. Common knowledge like being at a healthy weight, eating a balanced diet full of fruits, veggies, whole grains; these are great things to do for general well being. Everyone’s experience of pregnancy is different. Some people just feel awful the whole time, while others glow and adore every aspect of pregnancy. Most of us fall somewhere in between with highs and lows across the full 40 weeks.

MS: In your role as a doula, did you find significant differences in pregnancies of women over 35 vs. those not over 35?

Sarah: There are differences between a pregnancy in your 20’s and early 30’s vs. over 35. Again, I am harping on the point of choosing the right provider again. Some providers view pregnancy as a normal physiological event that only requires intervention once there is a deviation from normal. Other providers see pregnancy as inherently risky that requires constant vigilance to avoid complications. Healthy women, age 35 and older often have normal boring pregnancies. Finding a provider who views pregnancy as a normal process is the first step to having lower interventions. Women over 35 are more likely to be offered higher level screenings that may not be necessary or helpful if the results are not something that you need.

Sometimes women who are over 35 may have had history of pregnancy losses, fertility difficulties, or complicated fertility treatments to become pregnant. Even women who have had hormone therapy, IVF or IUI to become pregnant can have a low tech, low intervention pregnancy. It can be difficult to change gears from frequent progesterone shots and ultrasounds to monthly appointments with no tests at all. We bring all of our life experiences, hopes and dreams right with us to pregnancy and birth. Our journey to pregnancy certainly shapes our experience. Someone who has tried for a long time with losses and disappointments along the way will have a different pregnancy than someone who conceived the first try. A complicated conception doesn’t mean a hard pregnancy and birth, nor does an easy conception promise a care free & easy pregnancy and birth. I do think that the harder the journey to pregnancy the more difficult it can be for expectant families to decline higher levels of screening which may or may not be needed. More information does not always illicit better outcomes; it can create anxiety where it doesn’t need to be experienced

MS: As a doula, nursing student, and mother yourself, what do you believe a woman should think about when deciding whether or not to have a baby when she reaches 35 + ?

Sarah: Deciding to have a baby is deeply personal. Pregnancy, childbirth, and motherhood are nearly ubiquitous roles for American women in their 30’s; so much so that my friends without children can be made to feel like outsiders as women. I wholly respect the decision to have or not have children. In my opinion there often isn’t a ‘perfect time’ to have a baby. Physiologically, a woman’s fertility does start to decline in her 30’s and significantly declines at 40 and beyond. If a woman is 35 and knows she would like to have a baby but isn’t ready or hasn’t found the right partner, harvesting and storing eggs is an option, although a pricey one. There are better IVF outcomes with younger eggs than older ones. So if a woman has the means and wants some more time, this can be a decent option.

If you are 35 or older, you shouldn’t let the whole ‘geriatric’ pregnancy label dissuade you. Consult with your MD or midwife about your plans to get pregnant and ask questions about how long it should take if you are coming off of hormonal contraception. There are ways to track ovulation to make sure your cycles are the appropriate length while also determining the best window for conception.

There are many things to consider when starting a family and every woman’s priorities are different. Motherhood and parenthood is a rollercoaster that impacts every single area of who you are as a person. Once a new baby enter’s a family their entire lives are totally changed. You learn to know yourself as a mother, your partner as a father/mother, and what was amazing and or horrible about your own childhood and parents. The desire to have children is great and biological. No one really knows what they are doing, but overwhelmingly we parents get a lot right and some wrong along the way.

MS: How can an older woman best prepare for pregnancy, birth, and/or motherhood?

Its really hard to prepare for something so unknown. My best advice is to have community. Read books, listen to the stories of women and mothers you aspire to be like, and attend childbirth classes that empower you to make your own best choice. Dream with your partner about how you will parent together and get through the big scary fears we all have, and go for it! My oldest child is 11 and there wasn’t quite the deluge of information on the internet when I was pregnant and home with a newborn. I distinctly remember being at home with a 2 week old baby, pouring through a baby manual, and coming to the realization that no one really knows what the hell they are doing. As parents we are all winging it to some degree. There is something comforting about this because it allows you to let go and get in touch with your instincts. Since then I have had clients show me elaborate graphs generated from Apps that show the number of feedings, diaper changes, burps, etc over the course of a day, week, month. This would not have been helpful to me. Read encouraging things, and not frightening things. There is no shortage of internet advice, child raising books, or anecdotal information that will undermine the power of your presence and your expertise about what your own child needs. Once you have read the facts about something, make an informed decision, follow your gut, and don’t look back.

My first baby what what we call a ‘high needs baby’ who wanted to be in arms and nurse constantly. I learned quickly to try my best to have a short memory, to not calculate how much sleep was accomplished or lost. Be in the moment. Try to find the joy in right now, or the hard in the moment with the knowledge that this too shall pass. In my mothering of older children now, I have to remind myself of the same lessons. Enjoy right now and let tomorrow worry about itself. That joyful/annoying stage is fleeting and will be different next week.

MS: Describe a doula’s role and how a doula can be important to a geriatric pregnancy.

Sarah: A doula provides physical, emotional, and educational supports to women and their families during pregnancy, childbirth, and the postpartum period. One of the things that can be a pro and con of a ‘geriatric pregnancy’ is that there is more life experience for expectant families. Older women who have careers and are used to being in charge of things can be really broadsided by how little control we actually have in pregnancy, birth, and the early days of mothering. Older women are used to be being competent and knowledgable about things, and suddenly they find themselves having no idea what to do. It is an uncomfortable yet completely normal part of the experience. Having an experienced doula to listen to you and normalize something that feels foreign can be very useful. Doulas are supportive of dads and partners too. Partners do not have to feel like the experience is solely riding on his shoulders. Birth is extremely intense for loved ones as well. They want to be helpful but often don’t want to do the wrong thing. The doula is like your birth consultant. She knows what is most important to you and will help you achieve it. The doula will let your partner be at his or her best. The birth partner should be there to love you and experience this with you. The doula can remind the partner to eat, take breaks, show how to rub the laboring mom’s back etc. Older couples often see the value in this type of service because it is like having expert comfort advice right at your finger tips. Doulas also have a knack for placing a cool cloth on your neck or feeding you ice chips without you needing to ask.

MS:  Anything else you’d like to share with our readers?

Sarah: You have options. Just because you have been seeing the same OB/GYN for 20 years doesn’t mean that they are the best fit for your care during pregnancy and birth. Your birth experience is something you will remember for your entire life. I have heard the most beautiful and appalling birth stories from elderly women who can recall very specific details about their births. Women remember.

Talk about your fears! Don’t hide them and foster them without the care of others. If you are being kept awake at night because of fear of childbirth, talk to your care provider and get connected with people who can share their positive stories. Our bodies are structured to do this. Look around at all the people around us and know that a mother somewhere birthed that person. There would be far fewer people on the planet if childbirth were always as horrible and scary as the worst story you have heard.

Lastly, ignore the cultural hazing of pregnant women. People scare pregnant women. You will never hear more awful birth and death stories or parenting nightmares as when you are pregnant. Unfortunately, women who are hurting often don’t have a place to share their pain about births that have gone wrong and a lot of that sharing lands at the feet of pregnant women. Its okay to not listen to that. More importantly, find positive and realistic stories rather than the worst case scenario tales.

I Just Want Love with a Person: Interview with Maggie

Blonde-haired, blue-eyed Maggie is an award-winning high school math teacher and Zumba instructor in Massachusetts. Maggie is not her real name because as a high school teacher she likes to keep herself off the internet. Maggie is the name she uses when she is out; her friends dubbed her Maggie because she is magnetic.

MS: How old are you?

Maggie: I’m going to be 42 on Monday.

MS: Do you want kids?

Maggie: Yes, I think so, I don’t know. I love kids.

MS: You said a fast “yes” and then “I think so,”  and then “I don’t know…”

Maggie: I think I would love to have kids and be a good mother and then I took it back because I don’t know if I’m going to have them. I still would want them. Or I would want someone else’s kids. Yeah, I want to be with kids. I would rather be with kids than not. That’s my answer. (Laughs)

I don’t know if I’m going to have them.

MS: You would rather be with kids even if they are someone else’s kids and you got into a relationship with that person…

Maggie: or foster or adoption…

MS: So, do you think about adoption?

Maggie: I don’t think I’m strong enough to do adoption yet. If I felt that strongly about it I think I would have already started looking into it. Now, it’s just thinking about mentoring, Big Brother, Big Sister, fostering.

MS: Do you have a plan to foster or is it just in the back of your head?

Maggie: No plan, it’s just a possibility.

MS: Do you feel any sense of urgency when it comes to getting kids into your life?

Maggie: No, I might have thought that in the past, like six or seven years ago.

MS: Why do you think it doesn’t feel as urgent now that you are turning 42? Why is it less urgent now that you are older?

Maggie: Maybe because you have no control over having your own children, and I thought I did before, and I’m just realizing I don’t.

MS: What are your reservations about fostering?

Maggie: Committing 100% of my life to it and not being able to afford it, but I think they help you. But I would love it. I would want an older kid. Not under 5. Older than 5.

MS:  Why?

Maggie:  I think that part of raising children sucks. (laughs) It appears to from every single person I know. It just seems really hard until they can do things on their own and function with other people.

MS:  Not that the teenage years are easy.

Maggie: No, but I love them. I am with them all day and I love them.

MS: Does being a teacher scratch the mom itch at all?

Maggie: You definitely get to give all of your love to kids. Maybe you don’t get all the love back.

Someone told me: don’t have kids to have love. That’s not really fair to the kid. I am 50/50 on that because that is unconditional love.

MS: Do you think that’s a part of why you want to have a kid?

Maggie: I thought it was, but

I think I really just want love with a person and not a kid. I would like to have kids but I think I really want love more. Love.

MS: Do you think there will be a point, if you have not met anybody, that you will take action and try to foster a kid or adopt a kid or are you just not going to think about that until you have to think about that? Read more