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Participant Five: Ryan
Demographic Information. Ryan, a twenty-eight year-old, Italian-Slavic- American, Catholic male, participated in the present investigation. He works as a computer programmer and has been married to his wife, Megan, for three years. Ryan and Megan incurred two losses within the past year. Their baby, Pat (gender unknown), miscarried eight months ago, and their daughter, Belinda, was stillborn three months ago.
Recruitment Process. Ryan was recruited into this investigation after he responded to an ad in a perinatal loss support group newsletter. During the telephone screen, he explained that he had recently incurred two losses and that he would very much like to participate in the study. After ensuring that he met the requirements for the study, this investigator scheduled the first meeting.
Description of the First Loss: Miscarriage. Ryan’s wife, Megan, had a miscarriage eight months ago when she was eleven weeks pregnant. Megan first thought that something might be wrong with the baby when she started bleeding on Thanksgiving weekend. On her doctor’s recommendation, she stayed on bed rest the entire weekend. The following Monday, Ryan and Megan went to see the doctor. The ultrasound scan told them that “nothing was right.” Essentially, the amniotic sac was collapsing, and their baby had died. Megan had a Dilation and Curettage procedure, which removes the remains of the baby from the uterus. Megan and Ryan named their baby Pat, a name that can be used either for males or females, as they did not know the gender of the baby.
Description of the Second Loss: Stillbirth. Megan became pregnant with Belinda one month after the miscarriage. Ryan did not think that he had a “good idea of what was happening throughout the process” when Megan was pregnant with Pat; therefore, they had frequent ultrasounds with this second pregnancy. During the first few months of her pregnancy (exact time unknown), Megan started bleeding slightly. When she and Ryan went to the ultrasound, they learned that there was a problem with the amniotic sac. Megan was put on bed rest and began going to a perinatologist for more ultrasound monitoring. Twenty weeks into the pregnancy Megan and Ryan went to an ultrasound appointment to “make sure everything was okay.” When Ryan saw the ultrasound scan this time he saw that their baby’s shoulders were hunched over and “knew exactly what happened.” Belinda had died. The doctor told Ryan and Megan that they had to deliver that day; therefore, they went directly to the hospital. Their friends and family came to the delivery. Twenty-nine hours later, the nurse told them that Megan would deliver between ten minutes and one hour. The nurse left the room to tell their friends and family. With only Megan, Ryan, and the anesthesiologist in the room, Belinda was born, “sliding right out.”
The interview occurred in two sessions, each six days apart. The first meeting lasted one and a half hours, while the second lasted one hour. Ryan was cooperative and answered questions enthusiastically throughout both meetings. In the beginning of the first interview, Ryan asked the investigator to move some toys that were in the office because seeing them was “upsetting” for him. He had difficulty staying focused during the first half of the interview, often providing lengthy answers and forgetting the questions that were asked. As the interview progressed, however, he stayed more focused on the topic of discussion, especially when asked specifically about his feelings.
The following several paragraphs summarize Ryan’s interview, including his desire for children, his experiences of both pregnancies, his reactions to the miscarriage, his reactions to the stillbirth, and how his reactions to both losses differed from each other. Later, sections that summarize his PGS scores and his projective test results will be presented.
Desire for Children. Ryan has “almost always” wanted children. As a child, he wanted to be a father. When he was a teenager, however, he decided that he did not want children because “I didn’t want them growing up in this world.” In his twenties, he worked as a nanny and decided that he wanted to have children because “they were cool.” Ryan began his relationship with Megan in his late twenties and, when he learned that she wanted four children, he told her, “I’m good for it.”
Ryan’s Experiences During the First Pregnancy. When Ryan first learned that Megan was pregnant with Pat, he felt very excited. He told a number of his family and friends. Ryan, however, did not feel very attached to Pat. He explained that he never heard her heartbeat, “wasn’t bonded,” and had “no idea what was going on” during the pregnancy.
Reactions to the Miscarriage. Although Ryan felt shocked when he first learned that Megan had miscarried, he did not think the loss was “a big deal.” He justified the loss, telling himself, “it was meant to be” because maybe if she survived, something “really bad” would have happened to her. The following narrative illustrates Ryan’s justification of Pat’s death:
For me, I had realized that it was better that way, that it happened. I had justified in my mind that there may have been something drastically wrong with the child because maybe the child would go through murder, there’s killers, there’s some sort of pain. I had justified in my mind that it was going to be okay.
Although at the time of the miscarriage, Ryan had no idea that “it was a big event in my life,” he reported that he now views the miscarriage as a major loss.
Ryan’s Experiences During the Second Pregnancy. Ryan had mixed feelings about Megan’s second pregnancy, especially because it was so soon after the miscarriage. That is, he was excited that he was going to have a baby, and feared the “impending doom of not being able to carry to term.” For Ryan, it was essential that he “put on a happy face” for Megan, never mentioning his fears to her. Ryan continued to justify Pat’s death during the second pregnancy, thinking that she was “meant” to die so that this second child could be born.
Early in the pregnancy, when Ryan learned about the separation of the amniotic sac, he became more scared. Simultaneously, he told himself that nothing bad could happen to this baby. Rather than “considering bad things as possible options of what could happen,” he focused on being excited about the baby.
Unlike with the first pregnancy, Ryan described being very involved with the second one. He helped with much of the housework because he “would try to have her relax as much as possible because if stress caused the first one, I didn’t want her to do laundry and have a second mishap.” Essentially, he tried to be “generally supportive and try to make her life easier.”
Because Ryan had not felt “bonded” with Pat, he wanted to get to know Belinda and “have a good idea of what is happening throughout the pregnancy.” Megan had earlier and more frequent ultrasounds scans, allowing Ryan to watch Belinda grow. Ryan described the first day he saw her arms moving as “the coolest day of my life.” Ryan elaborated on this experience by stating, “It was just amazing, that this little life form was already getting features that, you know, I didn’t know she had.” He was glad that he saw the ultrasound scans because “I needed that time that I was able to bond, that I didn’t have with the first one.”
To further facilitate bonding, Ryan engaged in several activities. First, he took several pictures at the ultrasound. Second, he built a website to share those pictures with his friends and family. Third, he bought a home heart monitor, which he was excited about because “you could hear things happening.” Fourth, Ryan read to Belinda while she was still in-utero.
Another way Ryan felt that he was able to “get to know” Belinda is through his wife’s morning sickness. Although he felt “bad” that she vomited at least once a day, he also felt that he was “getting to know her personality – like she hated pasta and salad.”
Ryan described making several preparations for Belinda’s arrival. He bought a mini-van, rebuilt his wife’s old crib, and spent his money more carefully (on items for Belinda rather than luxury items for his wife and himself). Ryan expressed excitement about building the crib, reporting that he “sanded, painted it nice and white, and put TLC into it.” Ryan and Megan also began planning the nursery; however, they did not go into “depth” because they were still thinking of their previous loss and had some doubt whether the baby would survive.
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