Lost pregnancies

Although all the women in this study have infertility challenges, most of these women have been pregnant at least once. With two exceptions, these pregnancies were the result of infertility treatments. While some women carry their pregnancies to term and have a baby, others miscarry or have a stillbirth. These latter women typically articulate what the authors interpret as a melancholic desire to return to when they were pregnant. This melancholy can often be traced back to a longing for what a pregnancy foreshadows: the future horizon of having a baby. However, some women also refer to the ways they can give meaning to themselves and their fetus during their pregnancy. Erica’s story exemplifies this. Having had a stillbirth 28 weeks into her pregnancy, she struggles with the question whether she is a mother. At the beginning of the interview, she reflects on how she felt when she was pregnant:

I felt like a true woman. Yes, I would give anything to experience that again. (…) The feeling of being a mother, oh, yes, so nice. I’ve experienced that; I had a son. (…) Or well, a mother, I don’t know, am I? (long silence) It’s hard. Awful (…) Am I? Are you a mother when you don’t have a child? Oh, I don’t know…

Erica’s words show that she longs for the feeling she had during her pregnancy, when she felt like a “true” woman and, as she hesitantly says a few sentences later, a mother. It may be argued that her longing for these two identities are intimately connected and coshaped through cultural discourses about normative womanhood. Although in Western societies there are increasing, multiple options for women to comply with accepted womanhood, such societies are still very much pronatalist.83 84 Erica’s longing for her pregnancy, then, may be interpreted as being shaped by the joyous experience of culturally approved womanhood through the feeling of being a mother. As such, her narrated experience shows us that melancholy is not lived and shaped within a mental vacuum—something a major body of psychopathological research assumes—but, rather, is situated within a sociocultural realm.85 86 In line with Kristeva’s understanding of melancholy as ‘bittersweet’, Erica’s account reveals that this normative longing has the double bind of being signified by sadness and by joy.87 Her melancholy, in other words, is coshaped through her lived happy memory of her pregnancy, in which she complied with normative cultural understandings, in this case, about the inseparable connection between women and motherhood.88 Simultaneously, Erica’s longing for these pregnant times is also a source for severe sadness: with losing her baby, she cannot actually live motherhood. Consequently, she struggles with how to make sense of herself, that is, with answering the question of whether she is a mother. In this sense, Erica’s melancholy may be interpreted as a desire for the blissful existential darkness of always having the lived memory of the anticipation to coincide with the norm of being a true woman (as a mother), while having the knowledge that this anticipated life will not be lived.

Later in the interview, Erica returns to the issue of questioning her identity as a mother. By talking about her stillbirth with the interviewer, she remembers forgotten details about the hours just after the delivery, most vividly her lived experience of how she held her son. In the following excerpt of the interview, it becomes clear that, in this renewed lived-through memory, she acquires a new understanding of herself as a mother89:

Erica: “I held him. It’s a bit of a blur, sorry. … He was given to me (by the nurse just after the delivery); I know that.”

Interviewer: “Do you remember how? How did that go?”

Erica: “I don’t know… It was in the wrong way. *pauses* It was; it was. His head was all wrong, too low. I… *starts crying*.”

Interviewer: “How wrong? Can you show me?”

Erica: “I wanted him higher up, here on the bump of my breast. *shows the interviewer the ideal position on her chest* (And) he was here. *shows where he was put on her chest and then pauses to blow her nose* All wrong. I think that (the former position) was the most comfortable for him. (…) I knew it immediately (how to hold him). It felt so natural … so natural … *pauses* I’ll be a great mother someday.”

Through narrating her story, Erica relives the pain of losing her son and acquires a renewed remembered experience of holding her baby: she remembers how she held her baby and that she immediately knew how to hold him. Through remembering this postdelivery moment, she can conform herself as “a great mother someday.” While Erica’s acquired memory does not seem to give her an answer to whether she currently is a mother, it does enable her to understand herself as becoming a great mother. In this sense, we may argue that we see Ricoeur’s narrative of mourning in practice.90 We see how narrating the lost past helps in remembering and, subsequently, how it assists with remembering losses differently, namely in a way a certain exemplary meaning of a memory is narrated that feeds into a forward-looking—instead of only a backward-looking or longing—understanding of oneself. In Erica’s case, this means that, while she was preoccupied with the question of whether she has become (and still is) a mother, by narrating and working through her memories of loss, she now understands herself as a future great mother.

Like Erica, Leanne also longs for her pregnancy. As a result of IVF treatment, she was pregnant for 11 weeks. This pregnancy made her feel like she had a child and, by extension, that she was a mother—a feeling that she still longs for today. Interestingly, this way of making sense of herself and her fetus developed in the few weeks before her miscarriage. She narrates her longing as follows:

I dream of it (being pregnant) every night—how fantastic it was. (…) And when we lost it (the fetus). Horrible, yes, yes … Well, it felt like we lost more than just cells. It was alive, life we created together. (…) The power that comes from the (ultrasound) images of … pff … it could only be a child. (…) I felt like a mother then.

Leanne’s words reveal that her way of understanding her fetus as a child and herself as a mother is shaped by a specific meaning of the senses in modern-day pregnancy practices. Nowadays, sonogram technology allows a sensory experience of the fetus early in the pregnancy—and one that can be shared with others—and, we maintain, envisions the fetus so that it may transform the pregnant woman–fetus relationship into a mother–child one. Verbeek argues that the ontological status of the fetus as a child comes about in ultrasound imaging because the fetus is explicitly ‘made present as a separate living being’,91 that is, independent from the body in which it is growing and with a ‘representation on the screen that makes it appear to have the size of a newborn baby’.92 For Leanne, then, it seems this specific technological mediation of seeing her fetus in isolation from her body shapes her understanding of her fetus as a child and her (early) pregnant self as a mother. With her miscarriage, she lost this sonogram-induced lived identity of being a mother, and she still longs for it today.

In her interview, Leanne displays a technologically mediated melancholy, and her attempts to overcome it and the various difficulties that accompany it. Like Erica, Leanne mourned her losses through narrating her past to—she says—“make peace with that time (of not maturing her pregnancy).” “It was very hard,” she recounted, “because I relived the pain every time I talked about it.” For Leanne, narrative mourning was also difficult because her miscarriage stories were not always welcomed—or even tolerated—by her social and work environment. As her friends and family—in her words—“grew tired of the stories,” she elected an intense therapy trajectory. Her company’s doctor urged her to start working full time again, thereby forcing her to stop her therapy sessions. Leanne’s account suggests that she is pressed to comply with what is, apparently, an accepted duration of longing for the past and trying to overcome her longing through story-telling. Thereby, she is given neither the appropriate time nor attention to mourn. Eventually, Leanne says this resulted “[in that] I basically had to deal with it alone. It was difficult, [and] it caused a burnout in the end.” Moreover, Leanne states that her mourning process was difficult because mourning’s pivotal aspect of talking about losses “does not promise anything.” Indeed, story-telling efforts do not guarantee that overcoming one’s longing for the past will come about. As such, we argue that Leanne’s account shows us that Ricoeur’s narrative mourning practice may be understood as a conditional unconditionality: women need to tell their stories to mourn, but the hoped-for result of story-telling—drawing out an exemplar memory that may reconstitute the self as forward-looking—remains an unconditional surplus of these women’s story-telling.93 Narrative mourning, in this sense, adheres to the paradoxical task of complying with mourning’s condition of story-telling, even though successful mourning remains unconditional. Leanne seems to deal with this difficult mourning by ritualising her meaning-making process. She says that, when she was finally “at peace” with having miscarried, she needed to let go of the lost pregnancy. For Leanne, this had a quite literal meaning. When she miscarried, she collected the fluids by sitting in her bathtub, put—what she believed was—the fetus/her child in a jar, and saved it in her nightstand for many years. First, the jar made her feel like “it (her child, the fetus) is still with me,” but when she was ready to move on, she recalls that she felt that it needed to be buried. This burial can be interpreted as the performance of a rite of passage in which she, through a spatial reconfiguration of a material memento, symbolically marks the end of her struggles and celebrates her life passage into a new and changed meaning of herself and her life.94 That is, saving the material remains of the fetus nearby seems to appropriately mark a time when she could not release the fetus, whereas the burial of the jar indicates an effort to let go.

Lost love lives

Infertility treatment is a taxing experience: the interviewed women describe the procedure’s physical invasiveness and the emotional rollercoaster that comes with it. These treatment aspects bear on women’s relationships. Some women describe a greater sense of intimacy with their partner—reporting that they “do it together” (Leanne) or that their partners have been “their rock” and a “great support” (Roxanne). Conversely, others emphasise the negative consequences of dealing differently with the treatment. They report more fighting with their partner (Josephine and Kate), or they become estranged from one another (Fay). All the participants emphasise the negative impact of infertility treatment on their sex lives. Many of them narrate that conceiving a baby has become an all-consuming quest. Accordingly, their sexual relationships are primarily instrumental, for the purpose of becoming pregnant. Many women in this study also state that their sex lives have changed because of the side effects of hormone medication. They report a decrease in libido, severe mood swings, or other bodily changes like a dry vagina and sensitive breasts. These alterations may be permanent or last long after the hormone treatment has ended. They may result in a less pleasurable sexual experience and/or a decreased frequency of sexual relations—up to the point that two of the interviewed women have not had sex in years.

Most women who report such relationship changes state that they often long to their preinfertility treatment lives, especially to their preinfertility relationships. They describe their wish to go back to a more emotionally stable and harmonious time or when their non-hormone-affected bodies allowed them to have better sex lives. These women’s longing, we argue, is coshaped by sheer bodily and emotional discomfort, and by the factor that their post-treatment bodies fall short of the normative concept of a ‘good relationship’. That is, these women seem to experience the side effects of their hormone treatment—a decreased libido, mood swings and a dry vagina—as undesirable, uncomfortable and even debilitating as they interfere with what several scholars argue is a modern romantic heterosexual relationship ideal.95–97 Among other things, this ideal pertains to the idea that stability is the foundation of a love relationship, that partners engage in regular sexual intercourse by way of penetration, that both are regularly aroused by one another, and that such arousal translates into bodily fluids, which allow (painless) penetration. These women’s wish to revert to an unaffected, preinfertility treatment life and body seems, at least in part, to be instigated by the experience of not being able to live up to this ideal (anymore).

More than merely expressing this ideal-affirmative melancholic wish, both Josephine and Fay even state that, considering their current changed bodies and lives, they regret opting for infertility treatment. Fay says:

I’ve lost a lot. My loving husband, basically, (and) a healthy body. (…) A great, super life. (…) We have lost too much because of it; we lost each other. (…) We’re lost.

What is interesting in Fay’s account of regret and melancholic longing is that her infertility treatment—unlike Josephine’s—was a success, medically speaking: she conceived and had a daughter through IVF. Consequently, her longing for the time before infertility treatment is deeply conflictual. She elaborates:

So, you’re the first person I’m telling this to. (…) Then (before the infertility treatment), I didn’t have what I wanted the most (ie, a child). Now I do, and I still want it as bad as I did then, but I would go back in a heartbeat (to her life before her infertility treatment) if I could. (…) But (she would go back) only if I did not know how wonderful she is (her daughter). (…) You cannot say that in real life. It’s just that I didn’t know what I had, how lucky I was. I was totally preoccupied with that (having a baby). I don’t want to sound ungrateful. I am. I mean, so many people helped me with that (having a baby). But well, it’s just not that easy.

In her statement, Fay expresses a temporally entangled and complex melancholic experience. While she presently lives what she had longed for before—having a child and being a mother—she now longs to return to the past where this lived present was not (yet) lived. More than that, she longs to revert to a past that she, when she actually lived it, took for granted. She said that, in earlier times, she did not appreciate her luck and was only directed towards her hoped-for future of having a child. In this sense, we may say that she longs for a past that she has never actually lived, that is, for a lost present that never really existed.

Fay’s wording, however, seems to contradict that she has never actually lived that particular past. While she merely points to her actually lived present—“it” or “that” as in: (having) a baby—she gives detailed descriptions of what she has lost (but never had) and adds many adjectives—“loving husband,” “healthy body,” and superlatives like a “great, super life.” Yet we may argue that such wording exactly fits her melancholic longing for a non-lived past. After all, the hermeneutical tradition teaches us that, in our stories, we represent our experiences and construct them.98 By adding lively wording to accounts of our past, these pasts become lived—again or anew—within and through our stories. In this sense, we could interpret Fay’s descriptive and detailed account of the past as an attempt to construct a lived experience of a past she never actually lived.

What further stands out in Fay’s melancholy account is that she begins by saying, “you’re the first person I’m telling this to.” It may be interpreted that she has not shared this experience with others for two reasons. First, Fay’s silence can be connected to her statement that her wish to go back to a life with a happy relationship implies a (preinfertility treatment) life without a child, even though she states that she still wants to have the child she now has. Here, we see that Freud’s (1958) asserted decreased meaning of the present in favour of the liveliness of the past may imply a cultural taboo.99 That is, for Fay, keeping her melancholy to herself seems to be related to the taboo of longing for a past, childless life when one is a mother.100 101 The fact that Fay’s desire only implicitly points to a childless life and, therefore, is rather ambiguous and very indirect, underscores the intensity of this taboo in our culture. Second, Fay’s silence also seems to be connected to the idea that she does not want to appear ungrateful because, as she says, “many people helped me with that (having a baby).” While she does not say to whom she refers, it may be argued that Fay (also) refers to her doctors and other medical professionals. Similar to what Garner documented, then, Fay’s words may hint at the unacceptability of being—or even appearing to be—ungrateful to biomedicine in infertility treatment.102 Biomedicine is perceived as offering women the privilege of a time-consuming, often expensive opportunity of having a baby. Then, in the situation of being granted the lived reality of infertility corrected by biomedicine, even hints at feeling ambiguous about this lived reality seem unacceptable.

Lost futures

While melancholy is generally seen to refer to a longing for a past, our study shows that it may also include the longing for a certain future.103 Indeed, the above-described accounts of melancholy over past lives and lost persons also adhere to the loss of a certain kind of future. For example, women adhere to a lost future as a mother within their desire for their lost pregnancy. Alternatively, when referring to a lost love life, they implicitly refer to the loss of a future with a happy relationship. Occasionally, however, women explicitly refer to their lost futures, namely where the primary object of their melancholy is a lost possibility. This is the case for most women for whom their infertility treatment has not been successful and/or for those who had to stop infertility treatment because of age restrictions, health risks or financial reasons. These women long for the lost possibility of being a mother. Emily is one of them. She underwent several, unsuccessful rounds of infertility treatment. On the day she turned 44, she had to stop her treatment since her insurance only covers the treatment up until the age of 43. For Emily, longing for the days in which she was in treatment is intimately connected to her longing for a future in which she is a mother. She elaborates:

I think back a lot to that period in my life. It (her infertility treatment) was so horrible, yes, with the uncertainty and that you do not know what will happen. But also, well, (that was) better than now. It was still an option (to become pregnant), you know. (…) A sense that you can do something about it (ie, the possibility of becoming pregnant). I had a routine, taking my (hormone medication) shots, exercising, supplementary pills, going to the hospital. The doctors telling you what to do, even. *laughs* It was nice to have that. (…) I am not ready to move on just yet. The possibility, yes, yes, I know, fantasy (of being able to become pregnant) still haunts me. And I like it in some way.

Although Emily experienced her infertility treatment as “horrible,” she still longs for those days. She even mentions liking her longing. The treatment provided her with a possible future of being a mother, something no longer possible. As such, Emily’s melancholy may be characterised as bittersweet, that is, as a vain hope—or “fantasy”—for her presently determinate future to become indeterminate again.104

In addition, Emily’s account reveals a chimerical inability to let go of a lost, indeterminate future. It adheres to an inability to relinquish a sense of having control over this future. Her infertility treatment opened up the future of motherhood and provided her with a range of practices—taking shots and supplementary pills, exercising, visiting the hospital and following doctors’ orders—that gave her a sense of control in attempting to transform that possibility of being a mother into an actuality. In the end, the possibility of motherhood turned out to be a “fantasy,” and her sense of control over transforming that possibility was fictional. Despite her best efforts, that possibility did not turn into an actuality. It seems that, for Emily, her possible future of motherhood—and with it, her sense of having control over this possibility—was taken from her because of an institutionalised policy of age-appropriate motherhood. It is argued that this policy is only to a limited extent based on medical knowledge about infertility treatment’s health risks and more so on cultural norms about the age of a ‘good’ mother.105 Accordingly, while biomedicine seems to provide a sense of control over one’s future, Emily’s account reveals that (not) having this sense of control—and, by implication, longing to having it again—is predominantly based on shared cultural ideas about appropriate motherhood.

Like Emily, Roxanne longs for the lost possibility of becoming a mother through infertility treatment. Two years after Roxanne’s son was born because of IVF treatment, she wanted another child. Unfortunately, another round of IVF treatment was considered too much of a health risk for her. Therefore, Roxanne’s desire to become a mother again has taken the shape of longing for the time in which she could endure infertility treatment. Recently, though, she has tried to mourn her losses and reorient herself to her future again. Besides elaborating on her mourning strategy of talking about her losses, she also details the pursuit of another approach to mourning:

I’ve been working hard to just be happy with what I have (and) focus on the chapters (of her life) to come. (Therefore,) I really wanted the embryo home: I couldn’t bear that it was just in some (nitrogen) tank in the hospital. (…) Oh, how difficult that was! They (the hospital staff) said (in a patronizing overtone): ‘Madam, you can’t just come and get it. That’s not how it works.’ They wanted me to donate it or something. What a headache case! (…) Now, the embryo is lying here (in straw, at home), waiting for me to do something with it. (…) I think that (doing something with the embryo) will help me to accept that that second (child) will never come. (…) To be honest, I do not yet know what I will do with it. But it will come to me, I think. (…) (Not knowing what to do with it) is difficult. Burn it? Or put it in a box with other memories? (…) Yes, only after that (ritual), will I accept it.

This quote makes clear that, for Roxanne, the embryo is the material representation of the possibility of having another child. As such, overcoming her longing for that child implies letting go of the embryo. She attempts to do so through a ritual—through “do(ing) something with it.” Interestingly, this planned ritual is not a marking of being able to let go of the past, as it is for Leanne. As suggested by the words “only after that (ritual), will I accept it,” Roxanne’s ritual mourning seems to be an attempt to create a new lived meaning of her past, that is, to enforce herself to (be able to) let go. Compared with Leanne, Roxanne’s mourning strategy may be interpreted as a more radical way of dealing with the difficult uncertainty in narrative mourning. While Leanne’s ritual is merely a symbolic and material demarcation of acquiring new meaning making through story-telling, Roxanne attempts to create new meaning within and through her stories, as well as by performing a ritual with the embryo. By finding an alternative way of creating meaning, she seems to (attempt to) sidestep the difficult uncertainty of meaning making in narrative mourning.

In the interview, Roxanne also reveals that meaning-creating ritual mourning comes with its own difficulties. First, Roxanne faces the challenging task of awaiting the moment she knows what to do with the embryo, only after which can she accept that she will not have a second child. She speculates about what she might do with the embryo. Like Leanne, that speculation takes the form of a reconfiguration of materiality: “burn it [the embryo], bury it […], make some art with it”—but she has to await the moment the appropriate ritual comes to her in a dream. So, although Roxanne’s ritual mourning is geared towards enforcing new meaning making, it seems that the ritual that establishes such sense making cannot be enforced and comes as a gift. This means that, while Roxanne’s mourning practice may be understood as a way to deal with the hard uncertainty in narrative mourning, her meaning-making effort also turns out to be quite uncertain itself: it depends on an unconditional, gift-like ritual. She must wait until the ritual comes to her. Second, her account shows that her plans to ritually dispose of her embryo go with fierce oppositions from the authorities—telling her “that’s not how it works.” Although women in the Netherlands are legally entitled to decide how to dispose of their embryos—having the choice between donating the embryo to other couples with fertility challenges, donating it to science, having it destroyed or bringing it home—Roxanne encounters norms that designate inappropriate disposal options—something that “bringing the embryo home” apparently is. Roxanne’s account shows that performing her embryo-disposal ritual and coming to terms with the lost possibility of becoming the mother of a second child is a “headache case,” because of the difficult nature of ritual mourning and restricting cultural norms.