Infertility and Pregnancy Loss, An Interview with Tracy Gilmour-Nimoy, LMFT

An interview with Tracy Gilmour-Nimoy, LMFT, PMH-C, on understanding infertility as well as pregnancy and infant loss. Curt and Katie interview Tracy, a certified perinatal mental health professional, on what the medical and mental health professions often miss related to reproductive health and pregnancy. We dig into the basics and common mistakes as well as the harm caused when therapists are uninformed. We explore trauma, grief, and the invisibility of these common struggles faced by some who want to have children.

It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.

Transcript

Click here to scroll to the podcast transcript.

Interview with Tracy Gilmour-Nimoy, LMFT and Certified Perinatal Mental Health Professional

Tracy is a Licensed Marriage and Family Therapist and Certified Perinatal Mental Health Professional. She has a group practice in San Diego, CA, where she specializes in working with individuals who have experiences of trauma, depression, anxiety, reproductive mental health, perinatal mental health, maternal mental health, paternal mental health, grief, loss, life transitions, and relational challenges, to name a few. In addition to her love of mental health, Tracy is an avid reader and writer. Her articles have appeared on her mental health blog and other public forums, such as Scary Mommy. She writes about varying mental health topics, as well as her personal experiences of infant loss, grief, and trauma. To learn more about Tracy, connect with her on Instagram @TGNtherapy

In this episode we talk about infertility and pregnancy loss:

• What we missed in our episode about navigating pregnancy
• How hidden infertility and pregnancy loss is in society, how the conversation is taboo
• The lack of trauma-informed care within the medical field
• The problems of assumptions around fertility and whether people want children
• The way that common questions can be triggering and traumatizing
• How dismissive of the grief people are when it deals with infant and pregnancy loss
• The rose-tinted lenses that hurt women during the whole process of getting pregnant and having a baby
• How hidden it is and how little discussed are all the stages of women’s development
• The gaps in therapist training related to infertility and pregnancy/infant loss
• The focus on the baby versus the parent

“Advocacy is key…connecting with other providers and training and advocating for change within the programs. Because…in our ethics…we don’t only do good but we have to do no harm. And harm has been done. And that is a problem. And we need to do better.” — Tracy Gilmour-Nimoy, LMFT, PMH-C

• Ideas for advocacy within the educational and medical systems
• The discomfort with sitting with these types of experiences and losses

“When someone’s grieving they’re not looking for a solution, they’re looking for a witness. They’re looking for someone to sit with them.” — Tracy Gilmour-Nimoy, LMFT, PMH-C

• The tendency of people wanting to fix it and move forward without accounting for loss and recognizing when it cannot be fixed
• The shadow losses and losses of an absence
• Holding space for grief and loss, for how horrible it is
• What therapists need to know about infertility
• The importance of understanding the medical terminology, the financial burden, the emotional implications of the fertility process
• The internal focus on how the body works and what to do for your body
• The identity aspects related to motherhood or not becoming a mother
• What therapists need to know about pregnancy and infancy loss

“Even if there is a child that comes home, a healthy child does not replace a child that is lost.” — Tracy Gilmour-Nimoy, LMFT, PMH-C

• The perception of the death of their child
• Traditions to honor the child who didn’t come home
• The importance of remembering dates for individuals who have infant and pregnancy loss
• Acknowledging loss, using language or names that are relevant
• Honoring how they view their parental status after a loss
• The importance of acknowledging the grief and the ability to manage your loss in our own way (i.e., not responding to people or not going to baby showers)
• The trauma of pregnancy loss and how that may show up in future pregnancies
• How women are dismissed by medical providers when they have a bad feeling during pregnancy and it often turns into a reality
• Ideas to support the non-pregnant partner and the differences in the grief process
• A brief discussion on how the pandemic has impacted the reproductive health process

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Heard Bookkeeping and Tax

As a therapist, you’re probably too preoccupied with your caseload to want to think about bookkeeping or tax filing. Heard Bookkeeping and Tax is a platform built specifically for therapists that helps you track and improve your practice’s financial health. Regardless of whether you’re a seasoned clinician or are in the first year of your practice, Heard will help you to identify areas for growth and streamline best financial practices for your business.

When you sign up with Heard, you’ll work directly with financial specialists to track your income and expenses, file taxes online, and grow your business. You’ll also receive financial insights such as profit and loss statements and personalized monthly reports. You can say goodbye to poring over spreadsheets and guessing your tax deductions or quarterly payments; focus on your clients, and Heard will take care of the rest.

Dr. Jennifer Kashani, a licensed clinical psychologist based in Los Angeles, says: Heard has simplified and streamlined bookkeeping and best business practices in a digestible and accessible way. Having the foundation of Heard for my business has made myself and, in turn, my patients feel more solid.

Plans begin at $60 per month and can easily be tailored to fit your business’ financial needs. You can schedule your first consultation at http://www.joinheard.com.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

TGNtherapy.com

Blog post from Tracy: I want my baby

Certified Perinatal Mental Health Professional through Postpartum Support International

Relevant Reading:

Good Moms Have Scary Thoughts–Karen Kleinman

Dropping the Baby and Other Scary Thoughts–Karen Kleinman

I Had a Miscarriage–Jessica Zucker

Infertility Counseling–Sharon Covington

Frozen Dreams–Allison Rosen, Jay Rosen

Coping With Infertility, Miscarriage, and Neonatal Loss–Amy Wenzel

The Trying Game–Amy Klein

Relevant Episodes of MTSG Podcast:

Navigating Pregnancy as a Therapist

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

—

Get Notified About Therapy Reimagined Conferences

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW

Music by Crystal Grooms Mangano https://groomsymusic.com

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).

… 0:00
(Opening Advertisement)

Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide where therapists live, breathe, and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 0:15
Welcome back modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And occasionally we hear from you, our listeners about things that we should address, things that we may have missed, things that we may have thought that we hit on and didn’t. And some combination of those things here is today’s episode. A couple of months ago, we had done an episode on pregnancy as a therapist. And we’d made a brief mention within that episode about infertility and kind of thought that we had done within the context of that episode, a recognition of a certain segment of clients who may struggle with some of the things that we had talked about in that episode. When we had recorded that episode, we had the very good intentions of helping out the segment of our listeners who may become pregnant during their work. And today’s guest reached out to us and said, you know, you’re really not doing enough when it comes to infertility. And Katie, and I had a longer conversation, we exchanged several messages back and forth with today’s guest, Tracy Gilmour-Nimoy. She’s a reproductive therapist. And we really recognize that, yeah, we missed the boat. So very thankful to have somebody helped bring that boat back to us and

Katie Vernoy 1:44
Boat back to us? Okay…

Curt Widhalm 1:45
We missed, we missed the boat. Yes. So bringing the boat back. Thank you so much for joining us, Tracy.

Tracy Gilmour-Nimoy 1:52
Yeah, thank you for having me. Happy to bring the boat back with you guys. And just thank you so much for being so receptive and open to that feedback. I’m really excited to be here.

Katie Vernoy 2:01
Well, and I think for me, and even as I’m talking, I’m deciding how much I’m going to say, because it’s a very personal topic to me.

Tracy Gilmour-Nimoy 2:11
Yeah.

Katie Vernoy 2:12
Curt, you said that we said we thought we had covered it. But but I didn’t. And and I realized in even in the episode that I was remaining silent, and not, not addressing things that I needed to address. I didn’t feel like I could say anything, because I would then be disclosing my own infertility journey. And I feel very bad that we didn’t cover it. And so I didn’t expect to get emotional right from the beginning. Maybe I should have practiced. I felt so relieved when you reached out to us and said that because it validated my experience of feeling like we had missed something, that we hadn’t settled the things, that it was something that we had allowed to stay silent. And it was something that actually, as you and I talked about, ended up in my therapists office. Thank you very much. And it was something where we were able to talk through why I remained silent. While why even though I am someone who likes to talk about really hard conversations, and about people who are often marginalized, I did not disclose my own fertility journey. I did not disclose my own struggles in this area, nor did I make sure that we addressed it in that conversation. And so I’m going to quickly turn this over, because I don’t want this to be about me. But our conversation was very powerful. And I really want and I’m very pleased that you were able to join us and talk about not just infertility, which I can I can join in and talk about that as far as the gaps and services, but also in pregnancy and infant loss and and how much as a society, we are silent on these topics. And oftentimes, extremely, I’m not thinking the right word here, but just insensitive to that journey and dismissive of that journey. And so, thank you so much for being willing to speak up because as I listened to the episode again, I realized how triggering it was and why it did not speak up. Thank you so much for being willing to share your your, your information here. And as I’m sure you know, since you listen to the podcast, the first question we ask for everyone is who are you and what are you putting out in the world?

Tracy Gilmour-Nimoy 4:43
Yeah, well, first, I just want to thank you for being vulnerable and sharing. And I think that the listeners will connect to your experience because, you know, fertility and pregnancy loss, reproductive health is such an isolating experience and the way that we talk about it in the medical world, in the mental health world, and so, you know, within social media is very isolating. And so I think that people will, you know, that will resonate with people. And it’s important to even just say, like, Hey, this is hard. And it’s hard for me to talk about too, I think, Katie and I when we originally met, I shared, like, gosh, I wrote that out, I, I sat with it, I kind of went back and forth. And then I was like, You know what, like, there are people that feel the same way. And so thank you for opening up the conversation. I really appreciate. So who am I? I’m a lot of things. You know, one of the big things is I’m a therapist, it’s a really important part of who I am and my identity. And I recently, you know, shifted my clinical focus. So you know, this time last year, I was just about eight months pregnant with my first child. I was getting ready to go on maternity leave, I was really excited about those challenges. And then in the third trimester, we ended up losing the baby. And so I had to go through a pretty quick process of being induced and go through this delivery. And aside from just the grief that comes with losing a child, I had a lot of medical trauma. I had a very, you know, sort of traumatic delivery and through that had trouble getting the therapy that I needed, had trouble getting the medical care that I needed. And that lack of trauma informed care and the awareness of hey, there are some huge service gaps here is what motivated me to shift my focus a little bit.

Curt Widhalm 6:31
as the one person on this podcast, who in my relationships, we’ve not had infertility issues, or these kinds of things. So I will be the learning wanderer through. And hopefully helping our listeners who might be in my position be more sensitive to creating the kind of environment to where these kinds of mistakes aren’t made. What kinds of mistakes, do people like me and other listeners in my position make so that way we can stop mistakes?

Tracy Gilmour-Nimoy 7:04
Yeah, thank you for asking. And I do think too it is important to mention that I don’t think there’s mal intent. I don’t think doctors have mal intentions. I don’t think therapists, I don’t think people we just don’t know, and we don’t talk about it. So it’s hard to know. So I really appreciate you asking. You know, the biggest thing is, you know, having these conversations and not assuming that everybody’s experience is the same. So not assuming that, you know, someone doesn’t want kids if they don’t have them, not assuming that they do want kids. And so just sort of like asking and asking if it’s okay to ask. You know, we asked so many of these personal questions. And you know, sometimes people don’t want to talk about them. It’s not their business. And so I think just opening up the dialogue is the biggest way to learn and change that.

Katie Vernoy 7:49
It’s so interesting that you say that, because I think I’ve gotten very snarky in that response.

Tracy Gilmour-Nimoy 7:56
Yeah.

Katie Vernoy 7:57
And I won’t go into it. Because it’s, you know, I’m not in therapy right now. But I think kind of magnifying that. I think that there is a privateness to whether it’s infertility, miscarriage, pregnancy loss, infant loss. And I don’t know if there’s preferred terms there because I, I actually did not go into that, because I didn’t feel like I could treat clients. And it seems like you’ve been able to make that shift pretty quickly. And that’s very impressive. But I think that there’s, there’s such a privacy that there’s a lot of assumptions made about whether whether someone is a parent, whether they should be a parent, and I appreciate you saying that, because I think that there’s so much that can be triggering…

Tracy Gilmour-Nimoy 8:41
Yeah.

Katie Vernoy 8:42
…with that, you know, asking a question like, Oh, do you have kids? is a question that everyone asks, and it can be very triggering. And, and in your case, and I don’t know how much of your story you want…

Tracy Gilmour-Nimoy 8:53
Yeah. Sure.

Katie Vernoy 8:55
…very traumatizing….

Tracy Gilmour-Nimoy 8:56
Yeah

Katie Vernoy 8:57
…about that.

Tracy Gilmour-Nimoy 8:58
Yeah. I mean, I remember even because it took us almost a year to get pregnant. And people would be like, oh, when are you going to have kids? And like, I’d like in my head like, oh my gosh, like I desperately am trying to have kids. But it’s like, I just met you like, why are you asking me that? Like, it’s so it’s so weird. Like, Hi, how are you? When are you having children? Like, I would never ask that to someone. It’s so weird. And that it is weird to like now being asked a follow up question like, Oh, do you have kids? And I always say, Yes, I do. And I’m like, I do respond sort of like in a snarky manner too and my husband is sometimes like, horrified by that. I’ll be like, Oh, well, my baby died. Because, you know, I’m not stripped of the title of being a mom because she’s not here with me. I think that’s the other thing too is people always say like, when there’s a loss, oh, you’ll be a mom one day. And it’s like, that’s so dismissive of everything that I’m going through. It so dismissive of my grief. Like if my parents were to pass, would you say you’re not a child anymore? Like, no, I’m still someone’s child. And so why do we do that in terms of like, pregnancy and infant loss? It’s so weird that we do that.

Curt Widhalm 10:02
So much of this is just kind of societal expectations as far as like, yeah, you’re, you’re of childbearing age. You’re…

Tracy Gilmour-Nimoy 10:10
Right.

Curt Widhalm 10:11
I sound like Dwight Schrute from The Office, all of a sudden. I’m trying to, you know, but there are these expectations of like…

Tracy Gilmour-Nimoy 10:11
Right.

Curt Widhalm 10:12
You’re of this age, this is the normal conversations for anybody else. That because this seems to be so taboo, that there isn’t any sort of roadmap other than like, you either ask or you’re completely silent. Because somehow as adults, we don’t know how to relate to each other unless it’s asking about these societal expectations.

Tracy Gilmour-Nimoy 10:38
Right? Yeah. And I think too, it’s like in the way that we ask. Like, even in like a completely, quote, unquote, normal trying to conceive period, pregnancy, delivery, and postpartum. Those things are really, really challenging. I haven’t met anyone who’s had a perfect everything. But the way that we talk about these things is like with rose tinted lenses. And that can be really harmful too. Like, I’m working with a lot of women now who like have postpartum depression or anxiety. And they come in, they feel so dismissed by providers, because they should feel fine. They should be happy they have a baby. And it’s like, why are we assuming that this is like always happy, positive? Sometimes people feel miserable throughout pregnancy, right? They’re still happy to be pregnant. But just, that doesn’t mean that it’s still 100% perfect all the time. So it’s not so much, I guess, that we can’t ask, but it’s like about how we ask and are we asking the right question? And are we being mindful and sensitive in the way that we ask?

… 11:38
(Advertsement Break)

Katie Vernoy 11:39
To me the thing that comes up, and as I’m aging, I start thinking about the whole female journey, and how so much of it is hidden. I am not yet entering menopause, but I don’t know much about it. And it seems weird to me. And…

Tracy Gilmour-Nimoy 11:56
It’s weird.

Katie Vernoy 11:56
And I know that’s outside of the topics I will re… you know, refocus, but I think…

Tracy Gilmour-Nimoy 12:00
No, but it is in the topic.

Katie Vernoy 12:03
But it’s just so centered on everything that that happened to women that happens to women has to be hidden. If it is bad, if it’s uncomfortable, or if it requires bodily fluids, then we’re dirty. Like it’s just all of this stuff, where it’s a thing where we just can’t talk about it and pregnancy and bearing a child, which for a lot of societies potentially still are this way but had been that’s that’s the woman’s purpose. So then it’s it’s hidden, it’s it’s rainbows and flowers and unicorns, and from super horrible morning sickness, and kind of that kind of stuff, all of those things all the way through to traumatic preterm birth or, or, or pregnancy loss or…

Tracy Gilmour-Nimoy 12:48
Right.

Katie Vernoy 12:49
…you know, kind of having a healthy baby and then getting postpartum depression. Like all of that is not allowed. We can’t talk about it.

Tracy Gilmour-Nimoy 12:57
Yeah. And it’s such an issue, because we’re not taught about things that we tend to experience. So it’s like, we’re not taught up, taught about menstruation. Like, you’re right, we’re told that, you know, don’t tell anyone. They’re called sanitary products, which implies that we are dirty. And then we’re not no one prepped me like, Hey, here’s what to expect during pregnancy, here’s what to expect during your delivery. Here’s what to expect during your postpartum period. And so like, I went home, and I was like, sweating through the night, I mean, I had breast milk coming in, and I was like, Is this normal, like, is something wrong with me? I had no idea. And every woman that I’ve spoken with that has gone through that is like, oh, yeah, no one ever, like taught me about that. You just learned from other women. And I was like, that’s a problem. Like, we need to talk about it.

Katie Vernoy 13:41
A huge problem.

Tracy Gilmour-Nimoy 13:42
Yeah, I mean, how are we supposed to, you know, do better if like, we can’t even talk about the normal stuff. Like, then, of course, it’s a reach to talk about the stuff that happens with loss or fertility challenges.

Katie Vernoy 13:54
Yeah, and I think the the piece that is doubly challenging is that there’s the societal stuff. You know, everybody is supposed to, to be married off with one partner, it’s supposed to be hetero, and then it’s also supposed to have kids involved. And if that doesn’t happen, then somehow you’re under a microscope, and why didn’t you meet one of these milestones? And so that’s, okay, so that’s kind of the societal element of it. And then there’s just therapists responding to this or even…

Tracy Gilmour-Nimoy 14:25
Yeah.

Curt Widhalm 14:25
Even gaps gaps within therapist training that…

Tracy Gilmour-Nimoy 14:29
Oh.

Curt Widhalm 14:31
…there at least in our master’s level programs here in California it…

Tracy Gilmour-Nimoy 14:36
Yeah.

Curt Widhalm 14:37
This would seemingly fall under the Human Sexuality course which is criminally short in the first place.

Katie Vernoy 14:43
Yeah.

Curt Widhalm 14:44
I don’t remember this being a topic discussed at all within that program.

Katie Vernoy 14:48
Yeah.

Tracy Gilmour-Nimoy 14:49
Yeah, I’m so glad that you said that because I can share with you I went to school in California too. I went to a like a very, you know, well known, accredited by all regards, great program. And I did not receive one class in fertility, you know, pregnancy, postpartum at all. I did not receive any training. And I received like a pretty thorough training to kind of get, like a taster of each pretty much each population but this. And then I went through my own experience and had such a hard time finding qualified therapists. And I was like, Oh my gosh, like, I have to specialize in this because no one knows how to support these families, these people who are going through this. And I actually wrote a letter to my graduate program to the dean, I said, Hey, you know, the program is so great, here’s everything that I love about it, but I wanted to get some feedback about, you know, an area that I think really needs more focus. Like, we need to talk about these things. And I went through like some of the statistics. You know, it’s like one in eight couples will experience fertility challenges, one in four, a loss, you know, pregnancies end in a loss, one in four people will have a loss. And so basically, the response was something to the effect of 70% of our students get a solid lecture in parenting.

Katie Vernoy 16:07
Oh, dear.

Curt Widhalm 16:08
Oh no.

Tracy Gilmour-Nimoy 16:08
And I, you know, it’s like parenting, first of all, is completely different. And it also just speaks to the message of we care about the baby and not the mom. And this is so true. The second someone gives birth, it’s all about the baby. No one cares about the mom. It’s the baby, you know, sleeping, is the baby feedin okay? And it’s like, what about the mom who just went through so many physiological and emotional changes, who’s staying up all night, who is running on empty? And you’re only asking about the baby. The best thing for the baby is a healthy parent.

Curt Widhalm 16:42
Yes.

Tracy Gilmour-Nimoy 16:43
And so yeah, I think there are gaps within like education and training. And that’s, you know, with all providers; physicians, if we’re not trained in it, as mental health providers, you can bet physicians are not trained in it. And that was one of the biggest things too, it’s just like the lack of trauma informed care. I mean, I remember going for a follow up visit and being placed in a room full of baby photos. I remember being congratulated by multiple providers on the birth of my child. I remember at the hospital, there wasn’t a separate waiting room for parents, you know, like me who were being induced for a stillbirth. So I was with all the happy parents, balloons, stuffed animals, smiles, I was wheeled out with moms holding their babies, and I was wheeled out without mine. So, you know, just the way that we even support women who are going through a loss is not okay, it’s re-traumatizing. And, you know, people are re-traumatized. And I was re-traumatized consistently throughout the postpartum period.

Curt Widhalm 17:44
How do we fix this? Like?

Katie Vernoy 17:48
I mean this is really uncomfortable. So how do we fix it?

Curt Widhalm 17:50
I’m going into into solution mode here. Because yes, I mean, out of, in preparation of this episode, I did do, like I’m not coming into this completely blind. And one of the only things that I’ve come across is the there’s a book by Janet Jaffe, Reproductive Trauma: Psychotherapy With Infertility and Pregnancy Loss Clients. This seems to be kind of like one of the only things that’s out there. Outside of advocating to programs that don’t want to hear us that don’t want to make institutional changes. You’re here, you’re helping us broadcast this out to our audience. What other kinds of ways can we put this to help make it to where such a significant portion of the population is…

Tracy Gilmour-Nimoy 18:37
Yeah.

Curt Widhalm 18:38
being re-traumatized so often?

Tracy Gilmour-Nimoy 18:41
Yeah, I think advocacy is key. And it’s why I sent that letter to my graduate program. I sent a letter to the hospital. And I ended up speaking to like one of the VPs there. And essentially, I wrote a very detailed email, like, all the stuff I experienced, and she called me and she said, I read your email every day for a week before calling you. And imagined what it would be like if I was you, and I would feel the exact same way. And so she shared with me plans to amend some of those things. And then I gave feedback to my doctor about like, Hey, don’t put a woman who’s had a loss in a room full of baby photos, or even a woman who’s trying to get pregnant and isn’t. You know, prep your staff, have them review the chart before they call and congratulate, right? And if the staff can’t say like, Hey, I’m so sad or sorry to hear about your loss, like then they don’t say anything, right? Don’t have the staff call and be like, how are you? Right? I have people calling me how are you? Well, not great, you know. So, I think like advocacy is key and you know, you know, connecting with other providers and training and advocating for change within the programs. Because providers are leaving programs ill equipped to work with this population. And you know, in our ethics, it’s like we don’t only do good but we have to do no harm. And harm has been done. And that is a problem. And we need to do better.

Katie Vernoy 20:07
And I think the need for advocacy is huge. And of course, I’m, I’m with you on that. I think the the need for education and training and more than just a single book that Curt’s able to find on a Google search, because I could not find a therapist.

Tracy Gilmour-Nimoy 20:23
Yeah.

Katie Vernoy 20:24
I could absolutely not find a therapist, and I love my therapist, but she doesn’t get it.

Tracy Gilmour-Nimoy 20:30
Right.

Katie Vernoy 20:30
And, and so it’s having folks who have lived experience and or who have a great level of sensitivity, be able to serve this population. Because I just think it’s so it’s something people don’t want to think about. And it’s so foreign to their own experience, that it’s hard to get to a place where we can sit with it. And most people want to go to the fixing it. Right?

Tracy Gilmour-Nimoy 20:54
Right.

Katie Vernoy 20:54
You’ll get pregnant someday, or or it’ll be okay or, you know, it’s that kind of, you know, how do we how do we you know, what else have you tried? Or what other steps can you take? Or did you go on vacation? Did you try to adopt? Like it’s like, because people people have a hard time sitting in this constant loss. And I don’t know, I don’t know. Were you the one that wrote the article, kind of this loss of an absence? I don’t remember. It’s like an absence loss versus a loss loss. I don’t know. I’ll try…

Tracy Gilmour-Nimoy 21:23
The shadow like the shadow losses?

Katie Vernoy 21:25
Yeah, the shadow loss. Yeah.

Tracy Gilmour-Nimoy 21:26
Yeah, that’s exactly it. And something to remember is that there’s grief and loss at every stage, right? If a woman doesn’t have the delivery she wanted, that’s a loss. If a woman wanted a girl and has the boy, that’s a loss. I mean, there’s they’re just losses upon losses upon losses, aside from like a miscarriage or a stillbirth. There are a lot of losses. A lot of people who adopt, there’s the grief that comes with not being able to have a genetic child. And so it’s loss after loss after loss. And, you know, we don’t, we’re so anti-grief, anti-pain that we do tend to like, go to like, Hey, let me fix it. And some things just can’t be fixed. And in grief work, the biggest tool I use, because I do a lot of grief work is just holding space, and just saying, This is so awful. This is so awful, I wish it was different for you. I can’t change that. What I can’t do is support you and be here with you. And when I say that to people, they’re like, oh, my gosh, you’re the first person who’s just sad how awful it is. You’re the first person who didn’t tell me to do this or to do that. And I think that that’s the biggest thing to remember is that when someone’s grieving, they’re not looking for a solution. They’re looking for a witness. They’re looking for someone to sit with them, as they say, oh my gosh, my life exploded. This is so awful. And they’re looking for someone to sit with them in that so that they don’t feel as alone.

Katie Vernoy 22:47
Yeah. So I want to get a little bit more specific into what therapists should know about each of these stages. And just to add to your list of losses, there’s also a loss of identity if you don’t ever get to be a parent. So I want to…

Tracy Gilmour-Nimoy 23:01
Yeah.

Katie Vernoy 23:01
…also say that loss, too. So what a therapist needs to know about infertility and the fertility process. And I can report on this one. So…

Tracy Gilmour-Nimoy 23:10
Totally yeah. I mean, there’s so much. And the one thing I will say is that like even with this like credential, which is fairly new, the certified perinatal mental health professional, which is through Postpartum Support International, and is only a thing since 2018. So just shows that the gap in the field that there are then sub-specialties. So I did go to a therapist who said, Yes, I specialize in this, but they didn’t really specialize in loss or trauma. And so I really realized that there are specialties within this specialty and I think fertility is one of those. So with fertility, one of the most important things to be familiar with is the medical terminology. There are a lot of different treatments and medical intervention. And if you have a client who is going through that you, obviously you’re not a doctor, but you need to be familiar with what that entails. Because there are some differences. There is a huge financial burden that comes with fertility challenges. It’s typically not covered by insurance, which is so infuriating, because no one chooses fertility challenges. That’s not a choice. And so it’s either 100% out of pocket. In the best case scenario, I’ve heard of 50% cover, which is still 1000s and 1000s of dollars. It’s the physiological changes that come from hormones, there are hormone treatments being done. It’s sometimes surgery of egg retrieval. And so having an understanding of all the medical treatments, and then, like the emotional toll that all of those things take because it’s not just like a one and done it’s: You go in first you run a bunch of tests. And then if you proceed with a treatment, that’s, you know, that’s a whole nother thing. And then if that doesn’t work, there are other treatments. And so it’s a very long and exhausting process and all the while it’s a constant two week wait. So it’s the two weeks of trying to track ovulation. And then it’s the two weeks of taking pregnancy tests. And so it’s a constant waiting period, there is no break, there is no reprieve when someone is trying to conceive and are having difficulty. And so being familiar with all of those things.

… 25:17
(Advertisement Break)

Katie Vernoy 25:18
And I think the other thing that kind of speaking to the emotional piece is that there’s a big focus on the, an internal focus on your body, and what am I doing to make it work? Is this too much exercise, not enough exercise? And you can go down seven different rabbit holes on what you should do for diet.

Tracy Gilmour-Nimoy 25:39
Yeah.

Katie Vernoy 25:39
…or acupuncture. I mean, there’s just there’s so many different things and it becomes like your, the introspection, I don’t think is very helpful. I uncovered after years of this, but I think it’s that piece of like, okay, am I too stressed? Am I not stressed enough? Like it’s, it’s, it’s constantly watching your body to see if it’ll perform a function that increasingly more and more of your friends are able to perform. And it becomes this thing of, okay, what’s wrong? And I think the other element that I think is really important is a lot of women have identity as mother and/or as being in the process of being mother. And I think so then there’s, a lot of times people don’t know what to do with women who have infertility. They oftentimes either see them as kind of frittering away their childbearing years and not getting pregnant, not knowing what’s happening in the background, because most of us don’t talk about it. Or some sort of a, you know, I’m going to be a child free. And there’s a judgement if women don’t want children that can also play into that. And this could also be a generational thing as I’m a little bit older. But I think that there’s, there’s this huge emotional element to it, of, of identity. This is, the infertility process is so focused on your body in a way that most people don’t focus on in other times. There is an identity element, because you’re constantly in this waiting game of: Will I become what I’ve been trying to become? And then there’s the grief of that not becoming. And the thing that I had read at one point, and it was so resonant for me, is and it lives in for those of us fortunate enough to have an extra space that we’ve allotted to a child it lives in, how long do you wait to re, to re-situate that space? You know, how long do you keep the quote unquote, it’s going to be the baby’s room before you then turn it into an office or a guest room or like, utilize that space. I think that that’s, you know, kind of that picture of this space that is unformed, and that’s constantly, you know, not filled is part of it. And so I think that is also important to recognize, because it, it doesn’t go away. I have a client, where she and I have talked about that where even past childbearing years, there’s still that element of something that never got filled, that was missing.

Tracy Gilmour-Nimoy 25:43
Yeah. And there’s so much pressure placed on women to have children and to do it within a certain timeframe. I mean, we call, if someone who is 35 or older, we label that a geriatric pregnancy, or we call it advanced maternal age. Which is terrible terminology. And the other thing is, too, is the message is your body was created for this, this is natural, your body will know what to do. And so there’s a lot of shame. And a lot of the responsibility in the way is often on a female partner or the partner who is caring.

Katie Vernoy 28:39
Yeah.

Tracy Gilmour-Nimoy 28:40
And there’s a lot of shame there. Because it’s like, gosh, you see your friends, you you know, that you’re, you know, your mom had a kid and you know, everyone is pregnant and having children like, why can’t you do it? And then you put your body through so much. And I always tell people who are struggling with fertility and/or who have experienced a loss, I always say like the parenting doesn’t start when you bring a child home from the hospital. The parenting starts prior to even getting pregnant. Because when you’re trying to get pregnant, you are oftentimes taking prenatals, you’re tracking. I mean, you’re doing all sorts of things to prepare. You might want to be in a certain place, you know, in a certain place in your career, you might want to be in a certain financial situation, you might want to have a house, you know, so there are things that we do to parent before that. And then there are things that we do to parent throughout pregnancy. And then, of course after and I think that that’s really important to mention, because I think the energy that is put into this gets lost when people don’t show up with a living baby. It’s like, oh, you’re not a parent, you know, you didn’t try, you didn’t want it. And I think that that’s important to mention.

Katie Vernoy 29:48
What do you think therapists need to know about pregnancy loss and infant loss?

Tracy Gilmour-Nimoy 29:53
Yeah, I one of the most important things to know is that even if there is a child that comes home, a healthy child does not replace a child that is lost. And so honoring that understanding that that parent is grieving what they likely perceive as the death of their child. And so holding space for that what can be helpful is helping people to explore traditions to honor that baby that’s not here. So whether that’s doing something on like the due date, on the delivery date, celebrating something on Mother’s Day. I, you know, it looks different for each person. But there are different ways to sort of honor that child that’s really important. Remembering dates is really important. So when I have a mom who comes to me, and there has been a loss, I ask about when the due date was. I asked if there was, you know, a surgery for delivery or if there was an induction, so you know, labor and delivery, or if the baby was delivered, you know, vaginally miscarried, I asked what that date was. And I write those dates down, and I send them a message on those dates, like, Hey, I’m thinking of you like, I know, this day is extra hard, like, you know, holding you close today, holding you and your baby close today. The language that we use, so immediately when I get a referral, because people will seek me out for this, because they want a therapist who gets it. So I think that’s part of the appeal. And the first thing I will say, because, you know, it’ll often come like, either in a phone call or email and you know, they list a lot of information. The first thing I say is, I’m so so sad to hear about the loss of your sweet baby. Or I’ll say son or daughter, I use whatever language they use, asking if there is a name, asking how you live, how they would like you to refer to their loss. So I always say, Do you want me to say baby, do you want me to say, son? Do you want me to say, daughter? Do you want me to use the name? And so asking those questions. And the other big ones, too, are just sort of like, honoring, like their role, like as a parent, if that feels right, if they don’t identify as a parent, then you know, we wouldn’t push that. But most of the time they do. And honoring their sort of autonomy in being able to share what they want to share. And if they don’t want to share, that’s okay, too. So there is a lot of guilt that comes with miscarriage and stillbirth, where people say like, Oh, I feel like I should be talking about it, or people ask, and it’s on me to share. And I always tell people you get to choose. And if today you want to tell the world and if tomorrow you ignore everyone, that’s okay. And there, any expectation that’s placed on you is not right. This is about you, not the other people. And that’s something that I think we struggle with as a society with grief. It’s like, we reach out and then we get mad and say, Well, I reached out to you, and you didn’t contact me. And so letting, you know, people know that it’s not about anyone but you and you get to make the call.

Katie Vernoy 32:39
I think women have such a hard time focusing themselves. And I recognize I’m saying in a in a very gender binary. And I apologize for that. I’m very resonant with my own experience. But I think when someone is in the path to having a child, I think there’s that expectation that we will always focus outward, and not focusing on ourselves. Like I’ve had to tell people very blatantly like, I often do not go to baby showers. I just can’t do it.

Tracy Gilmour-Nimoy 33:08
Yeah. I will never go to one again.

Katie Vernoy 33:09
You have to support your friend. And like, I get that. I can support them in other ways. I don’t need to show up to specific events. And I think I really appreciate the conversation around people managing their grief in their own way.

Tracy Gilmour-Nimoy 33:21
Yeah, I mean, I will tell you, I will never go to a baby shower again, because I had a baby shower, and I had a nursery and I had to strip that nursery. So you know, it’s just something that you don’t think about. And I would never want someone to have to do that. So I would give a gift at the end. Yeah, yeah. And then, you know, also working with those who’ve experienced loss, a lot of the time they will try to get pregnant again. And so something that I forgot to mention is understanding that fear of future loss is a trauma response. And so I see this a lot like in the networking groups where people post like, oh, paranoid mom is, you know, stressed about losing a pregnancy. And then the first question I’ll ask, is there a history of loss? Yes. I’m like, Okay. Like, understand, so I tell people like it’s normal to fear recurrent loss. I said, for you, this is not just a fear, it’s a lived reality. Of course, you are scared. That’s okay. And so then it becomes about what can we do to support you, right? And a lot of times people say, Well, I Google? And so it’s like, okay, and then they’ll say, Well, I google and sometimes that’s helpful. Sometimes that’s not. So then it’s about like, helping them to explore like, parameters around that. So it’s like, okay, maybe we only Google X amount of time or, you know, maybe we only look at this source, you know. So you help them to sort of figure out what they need to do so that you know, it’s not going overboard, but it’s still helpful. And something that we didn’t mention that’s really important is that there’s a common pattern of women having a bad feeling throughout pregnancy and being dismissed by medical providers, only to end up having a loss. And it’s pretty much the story every time someone comes in. And there’s a lot of research about this, we don’t really know why we just know that it happens. That women are in tune with their bodies. And they know and I happen for me, the second I found out I was pregnant, I said, Something’s wrong with this baby. And I was constantly told no, no, no, throughout until essentially the end of the pregnancy. And we’re like, oh, yeah, something’s really wrong. And it happens all the time. And then women feel bad. So they don’t, you know, ask for what they need. And it’s just so isolating and devastating. And then when it happens, it’s like, oh, my gosh, like I was right. And then it becomes a fear of in a another pregnancy. Am I scared because I have that bad feeling and it was right before? Or am scared because this is a trauma. And I have talked about this with my own therapist, because obviously, she specializes in this too. And I was like, I don’t care. I’m gonna believe someone if they tell me something’s wrong. I don’t care if they if it’s trauma. What is the harm in believing someone? You can still help that, you know, help them to explore, you know, a care plan or, you know, ways that they can feel supported. But honestly, if they have a fear, and they feel better having an extra test after having a high risk pregnancy or a loss, why not? What is the, I just don’t know, what’s the harm. And that’s a little bit different, that’s important for therapists to know. Because I would say like the other stuff. As a clinician, we might be like, okay, like, there’s some anxiety here. We don’t want to, you know, appease that or enable that. But I think that that’s different when there has been a history of that.

Curt Widhalm 36:40
Do you have any special considerations or advice for working with partners with people who are going through this process as well?

Tracy Gilmour-Nimoy 36:49
Yeah, it’s such a good question. I’m glad you asked. Because the part that nonpregnant partners often forgotten. One of the most important things is letting them know that their experience, feelings and grief is valid, even if it looks different than that of their partners. And oftentimes, it will look different. And this can create stress within the couple. You know, whether that’s through couples therapy, or through them, you know, sorting through that, between the couple without support. Having those conversations of this is my experience, like what’s yours? And then having understanding that it’s okay, if they’re different, it doesn’t negate the other person’s experience. And that’s pretty common. And then that letting the non pregnant partner know, like, hey, it’s not just about the person who delivered or who was pregnant or who carried, you know, this is about you to it’s okay for you to express how you feel. It’s okay for you to need or to ask for support. You know, because the non-pregnant partner often feels like they have to sort of like come in and, you know, not express emotion and just sort of show up and their job is to hold it together. And I think like, what ends up happening a lot of the time is, the person who physically goes through the loss tends to grieve at a faster rate. I mean, there’s not really like a path for grief. And, you know, grief is not linear, but they tend to sort of feel very deeply earlier on. Whereas with a nonpregnant partner, there’s often a little bit more withdrawal. And then like, the processing happens at different paces. And so then like later on, like several months or a year later, the non pregnant partner might have an experience that the person who went through the pregnancy or delivery had earlier on, if that makes sense. I think just like something that’s really important, too quickly coverage, just how the pandemic has impacted all of this. I know everything is impacted by the pandemic, but something that’s unique to reproductive health is that no partners can go to any of the doctor’s appointments. And so with fertility…

Katie Vernoy 38:50
I didn’t about that, oh, my god.

Tracy Gilmour-Nimoy 38:52
Yeah. So with fertility or loss, women are having to go alone. And there were several appointments that I had to go through alone. And just, you know, the trauma and if there’s medical trauma that adds to and have in anytime there’s been a loss to any sort of reproductive appointment can be traumatizing. And so having to do those alone and not having anyone in the room is just so awful. And I understand, you know, I’m all about wearing masks and being safe. But I do wish that we would make exceptions for reproductive health because it’s already such an isolating experience and to have someone who is like going to the hospital for a DNC because they had a miscarriage or to have someone who was going for fertility appointments to not be able to have someone there with them is so awful. And so just think it’s important that I mentioned that.

Katie Vernoy 39:42
Thank you so much for sharing your knowledge…

Tracy Gilmour-Nimoy 39:44
Yeah.

Katie Vernoy 39:45
…and for helping me to talk about my stuff, too. I really appreciate that. Where can people find you?

Tracy Gilmour-Nimoy 39:54
Yeah, so the best place to find me would be on my website which is tgntherapy.com. So it’s just my initials. And then same name for my Instagram. And so I’d love to connect with people. So that sent me an email on Instagram.

Katie Vernoy 40:11
And you’re you’re writing some pretty amazing blogs. So we’ll also link to those blog posts in our show notes as well as these other.

Tracy Gilmour-Nimoy 40:18
Thank you. Yeah, I write a lot about my personal loss and grief and trauma. And I just the reason I do that is because I looked for stories and I couldn’t find them. And I just I want people to know that if you find yourself here, you’re not alone and nothing is wrong with you for being here. And there are others and we’re here with you and we’re here to support you. And that’s why I do it.

Curt Widhalm 40:44
We’ll include links to Tracy’s stuff in our show notes. You can find those at mtsgpodcast.com. And continue these discussions. You can connect with us on social media, you can join our Facebook group, the Modern Therapists Group, and we’re more than happy to take your feedback as listeners as evidenced by today’s show. And until next time, I’m Curt Widhalm with Katie Vernoy, and Tracy Gilmour-Nimoy.

… 40:49
(Advertisement Break)

Announcer 41:12
Thank you for listening to the modern therapists Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don’t forget to subscribe so you don’t miss any of our episodes.