The Emotional Hysterectomy

I write this post as kind of a lay person, even if I am a professional nurse with over twenty years experience, who has had a hysterectomy without having had any children. I went through my own grieving process in regard to never having my own biological children.  Albeit a short process of grief, I still grieved somewhat, well before my surgery  — at least two years.  

From fearing surgery complications to grieving the impending loss of fertility, deciding to have a hysterectomy can trigger emotions that other kinds of surgeries probably wouldn’t.

Every Day Health: The Emotional Impact of a Hysterectomy

Before my hysterectomy, my surgeon’s office asked me if it was OK if I was on the postpartum floor after surgery — the floor with the mommies who have recently given birth (or are about to do so).  Being a nurse for so many years, and more importantly having accepted my childlessness, I said yes, of course.

I wanted the expertise of the nurses who deal with women, and specifically those who have taken care of women who’ve had hysterectomies.  

The Postpartum/Gyn floors are generally newly-remodeled with up-to-date appearances to lure prospective mothers so they can be the boon for future word-of-mouth for the hospitals’ clean and new look.  Not all of the floors in a hospital are remodeled and decorated as nicely as the postpartum floor.

All remodeling and new furniture aside, I wanted the nurse who is accustomed and experienced in caring for GYN patients.  There is less room for error and the nurse would possess a sense of ease with a woman who has had her baby house excavated — she’s taken care of these patients before.  Although I may have been a refreshing type of patient for the med-surg floor nurse … a healthy recovery is primarily about me.  My physical needs and safety became tantamount in regard to my post-op care.  I didn’t want any ol’ nurse to take care of me, but one experienced in women’s health.

Some women cannot fathom being on a floor where a baby might appear or a pregnant woman may be seen … it can drive some women into a psychosis because the grief of a past lost child’s memory is still with them and/or they have not come to terms with their inability to reproduce.  In these cases, the woman may want to hold off on surgery until the emotional aspect has been more clearly dealt with through counseling and more time.  However, holding off on the hysterectomy may be impractical for whatever reason.  In these cases, then the woman should probably go to the med-surg floor if there isn’t a wing in the hospital specializing in only GYN patients.

While it’s normal to experience some anxiety before the procedure, it’s important to calm those fears before you have a hysterectomy. Not only has stress been linked to slower healing of wounds after surgery, but how you feel about a hysterectomy before you have it may also determine your emotions afterward.

From Every Day Health: The Emotional Impact of a Hysterectomy

The show-stopper in all of this is can be a woman’s level of readiness for a hysterectomy with the realization she can’t give birth to any more children, if she had any to begin with. Sure, there’s adoption and that’s a can of a whole lotta worms of a different color.  And simply because a woman has already had children or is too old to have children doesn’t mean she can’t grieve this loss.  Being emotionally ready to have a hysterectomy doesn’t effect only the childless.

In case you’d like to explore the experience of the adoption process, here’s an excellent blog to read written by a woman with a huge heart, a tender soul and a longing to be a mother: My Perfect Breakdown: Surviving. Living. Hoping. Recurrent Pregnancy Loss & Adoption.  (This is an aside, as the above blog writer is not interested in hysterectomy, not being the intent of her blog.)

anxiety no-mommy

Women who are depressed before having a hysterectomy tend to stay depressed afterward, says Kristen H. Kjerulff, MA, PhD, a psychologist, researcher, and professor in the departments of public health sciences and obstetrics and gynecology at the College of Medicine at Penn State University in Hershey.

My surgery was scheduled well after I accepted my infertility.  I didn’t know if there would be crying babies or not, if I would see dozens of pregnant women walking the halls getting ready to give birth while seeing every door decorated with congratulatory baby stuff.

My experience on the postpartum/GYN floor was a great one.  After my surgery and during my brief overnight stay, I didn’t hear one baby cry.  The only woman I saw walking the hallway was hooked up to an IV with the smallest of discernible baby bumps, so I  know she must have been there for some prenatal problems.  I saw a few doors with the baby decor, not thinking much of it either way.  I actually walked up to the nursery for viewing and was disappointed by the lack of babies present.  Then there was a man who saw me walking the hall and asked if I’d had a boy or girl.  I replied, “Neither.  I had a hysterectomy.”  He seemed shook up and apologized for asking the question.  I wasn’t offended or hurt.  He was simply a man who saw the world as every woman there having a baby.  I simply gave birth to a uterus!  (I also adopted that uterus out just so you know I didn’t bring it home with me.)

child my husband

There are some cases where a woman cannot ready herself for a hysterectomy because there isn’t ample time to think about the decision.  Cases like emergent hysterectomy after c-section or birth, usually from a ruptured uterus and/or uncontrollable postpartum hemorrhage doesn’t give the woman any time to think about hysterectomy; the choice of hysterectomy is made for her to save her life.  Even in advanced uterine and/or ovarian cancer, sometimes bowel, there isn’t time to mull over having a hysterectomy or not; it’s a surgery that needs to be performed sooner than later to risk having metastasis or impending death if the surgery isn’t done.

Ninety percent of hysterectomies are elective, meaning there is time to think of alternative procedures, medications and therapies.  In this time a woman can, and should prepare herself for the hysterectomy.  Some women may never come to terms with the permanence of not being able to give birth — even if they have already given birth ten or more times!

Probably one of greatest determining factors of emotional readiness for hysterectomy is how much a woman wants to have children.  If a woman doesn’t want children and never has, then the decision for hysterectomy is much easier.  If a woman has ambivalence about having children, the decision to have a hysterectomy can also be one of ambivalence.

I can relate to this: 

The parallel between my life some 45 odd years ago and my life now both fascinates and surprises me.  At times, it makes me sad.  And I wonder if I was predisposed to end up with a feline family rather than a human one.  Or if the instinctual choices I made as a child, influenced my trajectory as an adult.  Or if I missed the clear warning that I needed a better plan.  … [O]n a day like this … with my glorious kitties, I think, not a bad life.

Jane Ratcliffe – My Feline Family 

cat momma

In no way am I implying that a woman should not have a hysterectomy if she hasn’t come to terms with her own childlessness or inability to bear more children. However, simply being aware of this emotional sensitivity is key in recovery.  Like I stated previously, some women may never come to terms with their inability to bear children, but having the hysterectomy will offer a more pain-free and/or higher quality of life.

Certain strategies can help counteract the negative emotions that may come before having a hysterectomy.  Here’s a list with some suggestions from Every Day Health in regard to a smoother overall recovery from hysterectomy:

  1. Remember why you are having a hysterectomy.
  2. Know the facts on hysterectomy.
  3. Have a support system.
  4. Learn relaxation techniques.
  5. Anticipate symptoms during recovery.
  6. Talk openly with your doctor about your fears.
  7. Join an online support group like HysterSisters ONLINE GROUP.
  8. Order the FREE HysterSisters BOOKLET.
  9. Talk with other real life women who have had a hysterectomy.
  10. Let the nurses who care for you know about your concerns.

As for me … I remembered EVERY month why I wanted a hysterectomy  Every painful month.  The facts about hysterectomy, yep, I read up on all that asking my doc a plethora of questions, talking openly about all my concerns and fears.  My support system was my husband, myself and my cats — it may have been a small support system, but it was a quality one!  The healing of cat purrs … see below. Relaxation techniques — well, that’s called sleeping, taking it easy and napping … oh, and taking my pain medication routinely … all of those helped to relax me.  AND being on medical leave from work for four weeks — that relaxed me quite a bit!

* By the way, I’m not affiliated with HysterSisters in any way.  I simply found their free booklet very useful in my post-op experience.

cat purr healing

Old eggs & chromosomal abnormality

In 2012 I had an unexpected pregnancy … unexpected in the sense I had years and years and years of unexplained infertility.  Both my husband and I were delighted to discover that I was pregnant.  My pregnancy occurred at 43 and I was considered advanced maternal age (AMA).  If the pregnancy made it to term, I would have been 44 years at the birth.

I didn’t enter this pregnancy with blissful ignorance thinking everything would be all right.  I realized my age — being in my 40s and talked over what we would do if the prenatal diagnosis was poor.  My husband and I had had this talk well before we were married and were on the same page.

At 12 weeks the pregnancy was discovered positive for Trisomy 21 after a blood DNA test and a confirmatory CVS (chorionic villus sampling).  We elected to end this much wanted pregnancy in the first trimester just over 12 weeks. We were devastated because this was a much wanted pregnancy even though it was unplanned and completely unexpected.

I had a total of twenty-one weeks of a pain-free life — 12+ weeks for the pregnancy plus eight weeks after the termination for my period to return — free from the monthly dysmenorrhea pain.  It was the longest time I can remember being free of this pain … at least physically.  My emotions were consumed by grieving our loss.

I came to terms with many things since the time of our loss.  I now understand that even though a woman may be healthy physically, the eggs of a woman over 40 cannot compare biologically to a 20-year-old or even a woman in her early 30s.  My outside looked good, felt healthy but chromosomes of my residual egg reserve were damaged due to the natural process of aging.

perimenopause-my-eggs-are-shriveling-like-a-salted

More personal stories about TFMR (termination for medical reasons): 1 in 10 blog