Ep 71: Support for Donor-Assisted Families with Nancy Kaufman
Fertility Forward Episode 71:
Many parents who pursue donor-assisted reproduction often feel alone in their journey, but the truth is they usually share the same fears. Today we welcome back Nancy Kaufman, a licensed clinical social worker, and psychoanalyst who has been practicing in New York City for over 30 years. Nancy works with individuals, couples, and groups dealing with infertility and parenting after infertility. For the past 15 years, she has led The Third Party Parenting Network, a support group for those pursuing donor-assisted reproduction with an emphasis on issues related to disclosure. Today we discuss the value of walking through this process with a support group. Nancy sheds light on some of the common fears held by members of her support group, such as fears surrounding the rejection of a parent by a child who was conceived with the help of a donor, fears that a child is going to be genetically related to a lot of other children, and the tension that may arise between parents when one shares DNA with the child and the other does not. We discuss the importance of asking the question “Do I really want to be a parent?” and talk about how being a parent and having a genetically related child are not the same thing. To hear why you should disclose the truth about using a donor to your child from a young age, tips on how to navigate your child’s questions about the donor, and information about where you can find support for the challenges you face in your family journey, tune in today!
Rena: Hi everyone. We are Rena and Dara, and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our fertility forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients, because knowledge is power and you are your own best advocate.
Rena: I am so excited to welcome back to Fertility Forward today, Nancy Kaufman, a dear friend and colleague. She is a licensed clinical social worker and psychoanalyst practicing in New York City for over 30 years and works with individuals, couples, and groups dealing with infertility and parenting after infertility. For the past 10 years, she has led the Third Party Parenting network, a support group for those pursuing donor assisted reproduction with an emphasis on issues related to disclosure. Thank you so much for joining us today, Nancy. It is always such an honor to have you.
Nancy Kaufman: Pleasure. Thanks for having me back.
Rena: I'm so excited to have you on today to give your expertise on the area of donor, as this is something, you know, both you and I know so many people have so many questions about and struggle with and so to have your expertise on some of the most I think pressing questions is great. So I think let's start maybe by having you tell us about your group, Third Party Parenting Network, TPPN so people known about that. You know I send so many patients your way and I would love for people to learn about that. We can start with the importance of a support group.
Nancy Kaufman: I’m a big believer in support groups in general and particularly in the realm of fertility and donor assisted reproduction. The reason is that it provides an opportunity for people to be in a group of not only like-minded people but people who are literally experiencing the same feelings as each other. And they go into the groups thinking that they're the only ones who are having these very uncomfortable, difficult experiences and feelings and then to find people who are on similar journeys, having similar fears and heating out loud some of the same deep hidden feelings expressed out loud in a group can be a life-changing experience. It's very different than a personal therapy journey. And I think some people steer away from groups thinking well on top of everything, I don’t need group therapy at this point. And it’s very different. It's not an exploration of someone's childhood or someone's underlying problems. And does not link any problems that someone might be having through their infertility journey to something wrong with them. Quite the opposite. It’s an opportunity for people to feel supported, encouraged, and brought through the journey together.
Rena: And I think something that a lot of people voice that they’re concerned is that they’re worried that if they go into a group that they might feel scared hearing other people's stories or that their story isn’t “bad enough” and what I usually say is, well, you know, a good group isn’t so much about the individual story but about the overall experience and feelings everyone is experiencing. So that’s really what ii focuses on, as you said sort of these experiences and feelings that everyone is feeling across the board.
Nancy Kaufman: I think that's really true, Rena. The way I begin my group each time is to ask people to do a very brief go around of what brings them to the group today and what they'd like to get out of the group. So people will briefly introduce their story and where they are in their journey. And then I listen to the common themes that people talk about as they go around. And it is inevitably the case that even people with a different story or at different parts along their journey, the common themes are there. The common fears and the common concerns and that’s how we proceed - using individual stories and making a collective story out of it where everyone feels heard and understood.
Rena: Exactly. And I think some of those, maybe we can sort of move into some of the common themes people feel when using a donor. You know maybe fear of rejection I think is a common one and you know will if I use a donor will that child love me or will they think I’m not their parent? So what would you say to a patient with that fear?
Nancy Kaufman: Well, that is one of the common fears, as I said, people come in with remarkably similar fears and that one is close to the top of the list. People say, you know, I don't want my child to find out because they won't love me anymore. They won't think I'm the real parent. There's a flip side to that and we can talk about both parts of this. There's also a fear that because a child will be donor conceived that the intended parent might not feel like a parent. That the intended parent might fear rejecting the child. So let's talk about the first one. The fear that if the child knows or when the child finds out that they will reject the parent. So what I say to that, and it goes back to the issue of when a child does find out, when a child does know, and as you and I have spoken about before Rena, when a child grows up, always knowing their conception story from, organically, from a very early age that's built upon a developmentally appropriate way, that child does not suffer any kind of trauma related to finding something out that has some kind of negative impact that therefore might lead that child to reject a parent. Children who organically know their stories generally feel grateful to the parents as they grow into that understanding and don't feel rejecting of the intended parent at all. But what can be a cause for rejection is finding out their conception story at a later age when it not only is surprising information, but comes with a feeling of having been betrayed or like that's where the issue of rejection is finding out their conception story at a later age when it not only is surprising information but comes with a feeling of having been betrayed or lied to along the way. That’s where the issue of rejection can come in.
Rena: I think let’s expand on that a little more. If listeners, go back you and I did a podcast awhile ago. If they search online where we talk about how to kind of disclose but I think it is something everyone across the board always asks because no one ever knows. What do you advise? Do I disclose, do I not disclose? And so I know we talked about in the previous episode, but also now we’re kind of bringing it up, it is very much advised that you do tell the child that they were conceived from a donor. And this is not something you should not tell because it could lelad to some pretty serious effects and be pretty damaging to the relationship if you keep it a secret.
Nancy Kaufman: Well, family secrets in general in my view are, are not conducive to healthy family building. But this one has the additional component of feeling betrayed. And you know, it really, and we had touched on this before as well, but the more time that goes by the more true this becomes. It's not really an issue anymore because with the advent of commercial DNA testing, there is no more anonymity in donor assisted production. And in fact, intended parents need to consider that in a different and more comprehensive way than in the past. Is it's not simply a question of am I comfortable disclosing? But am I comfortable understanding that because it is so easy to find out that a child was donor conceived that you really cannot keep it secret, even if, even if you're intending to.
Rena: So what do you say to the person who says, well, I’m not going to tell?
Nancy Kaufman: Even in the near distant past, people would have that position. Many people did and perhaps still do. As professionals, we couldn't really go too much further with that. We can certainly outline the reasons why they might want to consider disclosure. Now, there is a more factually based reality that doesn't really even have to do with therapeutic benefit or what we even think might be best for the child or best for the family. There is a concrete reality that anonymity cannot be guaranteed. And we tell this to donors as well. In the recent past, donors were promised anonymity and that really cannot be told with certainty anymore. So both intended parents and donors have to understand the new reality. And we're hoping and finding that intended parents are perhaps more willing to consider that information in their position about disclosure.
Rena: What about parents who maybe they don't want to disclose because they're afraid of sort of opening that can of worms about well I don't want my child to be related to, you know, a million other kids who are going down that path and they think they’re kind of protecting them. What do we say to those?
Nancy Kaufman: It's a very, it's a very good point because as we see in the media so much now that is another reality that has come into play that as donor conceived individuals are more easily able to find and identify each other, the idea that there may be, and in fact, most probably are, other individuals conceived with the same donor, I don't like to use donor siblings because in terms of what makes us family a person conceived with the same donor is certainly genetically related, but not everyone considers them part of a family. Some people who find others conceived with the same donor do consider them to be siblings or family, or have a special relationship even if it doesn't have a particular word, but people feel differently about it. And I think that's important. The language is still being developed to encompass all of these different ideas, but to use the word sibling really instills a particular meaning onto a family that not every family may share.
Rena: I think those are all really good points. I think it’s become such a big part of our dialogue today as more and more people use DNA, more articles come out about finding out you’re related to a lot of other people and I think, you know, it sort of breeds a lot of fear in people, too, because they just don’t know. It seems very foreign.
Nancy Kaufman: Well,. it is a, it's a foreign idea. And it used to be that you, that an intended family didn't really have to think about that unless it was their desire to seek out these other people. What's changed is that you can be sought out even if you're not doing the seeking out. An example would be, let's say there's a, there's a family who did not disclose to their child and the child goes off to college and on a lark friends buy DNA testing kits for themselves as a holiday gift. And the test comes back. That college kid who did not know that they were donor conceived could get quite a, quite a lot of new information in the results from that DNA test. Not only information about a possible link to the donor, but also to multiple, multiple people who may have been conceived with the same donor.
Rena: Sure. I certainly see...I’ve had a couple patients who didn’t find they were conceived via donor until they went to conceive and needed fertility treatment and their health history came up. And when they went to their parents to ask them the question, they were told, oh, actually you were conceived via donor and it was, you know, you can imagine, it was traumatic to find out at that point in life.
Nancy Kaufman: And it's a, it's a, it's a trauma that doesn't have to be a trauma and can be completely diverted from the child.
Rena: Well what about you know something I see a lot is there’s a couple trying to conceive and you have whoever is using the donor, feeling very scared that either, you know, their partner will feel more bonded to the child because there will be the partner’s DNA or the child will feel more bonded to the parent whosever DNA it is. And it can cause a lot of stress and tension among partners. How do you kind of navigate that?
Nancy Kaufman: It is another one of those feelings that's near the top of almost everyone’s list. Will I be the odd person out? Will I feel left out of a very special relationship that a donor conceived child has with the genetically-related parent? Many of these topics that we're talking about are things that are very much on people's minds as they're contemplating moving forward using donor assistance. Once they have gone through the journey and have had their child, I see these concerns really receding into the background because what's missing in the journey that's full of concerns and fears is actual parenting. And once people have the experience, parents, they have a first hand experience and knowledge of who is the parent. I am the parent here, is the person who's getting up every night and taking care of a child or taking care of a child when they're sick, or crying, or needs them. This issue of who's going to have a more special relationship with the child comes up, not necessarily related to the issue of genetic connection. Some children and some parents bond differently with each other. So a child may be drawn to one parent, particularly at different developmental levels for the child. And it can be more difficult for an intended parent who is not the genetically related parent to see their child bond with the genetically-related parent and assume it's because of the genetic connection, especially if that is their only experience of parenting. People who have had a genetically related child, know more how that can swing back and forth. That one time a child might be connected to one parent and then another more connected to another. And that it has little to do with the genetic connection.
Rena: I mean that's a really good point, right? Parenting is difficult and it’s not always smooth sailing and you know, sometimes your kid just doesn’t like you or you don’t like your kid. And that’s part of life and it’s not because of genetics. It just is.
Nancy Kaufman: And people are fearful about that. And I think that there, what you mentioned, that there are times when a parent has had it with their child not because they're genetically related or not related, but because they've had a long day and they're tired and they want the kid to go to sleep. But people are afraid of feeling that because it's a non-genetically related child. But the experience of parenting as you just illustrated, is what can create that feeling.
Rena: Well it sounds like, you know, the unknown is always scary, right? We're always scared before we do something once whether that’s something we’re looking forward to or something we’re not looking forward to. Uncertainty and change can be very unsettling to humans. But I would imagine the recommendation is that it's so important for people to work through this now at the beginning of the journey, so that you don’t have these triggering feelings come up when your child is verbal, and then you're feeling, like, wait a second, is my child yelling at me because I’m not the genetic parent? And that that’s always triggering you. And so as both you and I know, it is very important to walk through this with a counselor, a therapist, to work through this at the beginning so then you can kind of go on and enjoy parenthood and all its trials and tribulations but not being triggered with these underlying fears and anxieties.
Nancy Kaufman: Absolutely. And what I'll add to that is to become familiar, as you're suggesting, with the, with the potential feelings that may arise for any parent and particularly certain concerns that may arise for intended parents of donor conceived children. And then along the way to revisit support when things do get triggered because of course as we know, just because you've dealt with it when it resurfaces again or at different times to build on that support can be very beneficial, particularly where the group can come in again in a group setting where those feelings are completely normalized and understood and accepted.
Rena: Absolutely. And I think you know parenthood regardless is daunting but when you introduce a donor it’s like an added layer and feeling kind of really alone and that’s why groups are so important to understand you’re not alone with these fears and to meet other people, connect with other people the same way. You know, it really does take a village to navigate this.
Nancy Kaufman: It certainly does. And it's, you know, there are differences in donor conceived families. It's not to suggest that, you know, once you make the decision, you have your child and that's the end of it.The real ongoing issue, as I see it, is to become comfortable with the decisions that you've made in your family and to help the child navigate whatever they're feeling as they go through the different developmental stages of understanding the story more and more and on a deeper and deeper level. The more a parent can accept all of the child's feelings, the better able they will be to help them. For example, as a child moves through different stages of understanding, they will often wonder out loud, well, who is the donor really to me? “Does that mean the donor is my mother?” is a question a child will often ask at around age seven or eight when the concept of the word donor solidifies into another human being who actually was the donor and who is that person to me, the child begins to think about in a new way. So when a child says is the donor, my mother? If the parents, or is the donor my father in the case of a sperm donation. The more a parent can feel unthreatened by the question and in fact invite questions, all questions, all feelings without a child intuiting that maybe they shouldn't ask this, or maybe they shouldn't say this because I, you know, I feel that that might be upsetting, the better able they can explore with the child. I always like to say, you can tell the child the facts, no, the, the donor is your mother or your father, I’m your mother, or your father if it’s a two parent family. And explain to the child in simple terms, depending on, on where they are on the developmental scale. But then let the child decide what language they want to use. Some children will say, well, I'm going to call that my donor mother. And you can, you can say, you can call. You can call them whatever you like. Just keep in mind that a mother is someone who intends to parent you, donors do not intend to be your parent, but you can decide what words you want to use. It can be very freeing for the parents to watch their child grow into an understanding that's based on facts and on their feelings, rather than the child feeling restricted by the fears of the parent.
Rena: I think that’s great and I think it touches on too a lot of this is relinquishing control and you know so much before this, what I usually do so much feeling loss of control. Maybe this wasn’t your choice and maybe you don’t want to be doing it. But for people to kind of go through the grieving process, right? There’s going to be a lot of grie about grieving this sort of vision you had. You know, if your vision was you’re in a two parent family and you were going to conceive and then you find out not only do you need fertility treatment you need a donor, there’s so much loss there. And that’s a really important part of the process and doing these exercises and to feel in control and to feel as though you have the power to take back your narrative and write your story. That that hasn’t been taken away.
Nancy Kaufman: Absolutely. And part of the loss that you just alluded to is the loss of an idea. An idea of how you thought things were going to be. No one grows up with the idea that, oh, I'm going to have a donor conceived family. So not only have you lost the idea, then by the time you get to contemplating using donor assistance, you have suffered probably repeated losses of many, many kinds, not just ideas.
Rena: Exactly. I think it’s that intangible loss I talk about with people. The loss we can’t see which makes it all the more difficult to mourn and a lot of times people don’t even realize that it’s there until they go to therapy or they go to a group and they talk about it and realize, wait a second, I didn’t even know I was mourning that? Ok, let me now go through the stages of grief and walk through that. I think otherwise unless people really take the space to figure that out most people try to power through and that’s when that can come back and you can be triggered later and it’s just very important to work through that and give yourself the space to mourn it and acknowledge it.
Nancy Kaufman: It's such an important point because otherwise you're, you're holding it and it really can interfere in sometimes taking the next steps. But even if you do take the next steps, it can interfere in how those steps are gone through. And something else that I like to encourage people to think about and to work through is who were those children that they had ideas about? How did they think of the child and how might that differ from the child that they are going to have? And that brings up another really interesting point, I think, in this whole process, which is the difference between being able to become pregnant using one's own genetic material or not and the idea of parenting. So the idea of who the child might be may be different, but that does not necessarily have to change the idea of how you would be with the parent. And so infertility, the focus is so much on being pregnant that the whole idea of parenting can get lost in the process when it's really becoming a parent that is the point of the whole thing.
Rena: I think that’s something I talk about so much with patients especially people who have been in the process for quite a long time. I don’t even know what I’m doing anymore. I don’t know if it’s just this challenge? Do I even want to be a parent? Do I even want a baby? Sometimes it gets so convoluted you can’t see the forest through the trees and I think it’s so important to stop and think about it and you know also to help people sort of understand they can have these two juxtaposing emotions. You can be happy about moving forward and using a donor and you’re continuing on your path but you can also be really sad that you can’t use your own biology and I think people often feel they have to feel one or the other or that they’re mourning this loss of their biology but I always give people permission to feel. It’s totally Ok and it’s so important
Nancy Kaufman: I love the question: Do I really want to be a parent? Because I think examining that as part of the journey, I wish everyone would examine that. So that question is really an important part of the whole package. And sometimes people may come to understand, perhaps they don't want to be parents. More often, it does seem that exploring that question helps them to separate the, how am I going to get pregnant question from do I want to be a parent? Because if the answer to do I want to be a parent, do I really want to be a parent, if that is, yes, then it's a slightly different question. OK. I want to be a parent. What is the best way for me to bring a child into this family? And that can really open up more possibilities or more acceptance to the idea because if the end goal is to parent, as opposed to the end goal, being, having a genetically related child, of course they're connected, but those are different.Those are different goals. And they have different answers.
Rena: Nancy, as always, that was such a wealth of information and I love that question you presented at the end. I think that will give people a lot to think about. So thank you so much for being on and sharing your knowledge and wisdom. I feel like there’s more on this podcast we could cover so we’ll definitely have to do another episode. The way I like to end the podcast if you remember is on a note of positivity. So sharing a gratitude. So do you have anything to share?
Nancy Kaufman: Oh I love that you end your podcast that way. And what I, what I will share today is how grateful I am even in what’s still our rather uncertain times to have had the opportunity to see you today using a virtual platform and to have been able to work with people through this very difficult year in this way, even when we couldn't be in person together. So I feel very grateful for that.
Rena: I love that and I will piggyback on that and you know so grateful to you and have your knowledge and wisdom and you being willing to give your time and to have TPPN to refer patients to you know I know they’re in great hands with you. And to have you you know I know you care so deeply about your work and to have someone out there moving forward in our field and coming out with new research papers that will hopefully help us keep working to change the stigma and everything that can go along with it.
Nancy Kaufman: And thank you, Rena for the wonderful work you’re doing as well.
Rena: Thanks, Nancy.
Dara: Thank you so much for listening today and always remember: practice gratitude, give a little love to someone else and yourself, and remember you are not alone. Find us on Instagram @fertility_forward and if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.