I told my ex I would never be a swinger. Now he won’t stop texting me
Before the lockdown, I had a boyfriend with whom I had been for 16 months. He said he wanted to experiment sexually with another couple, which I found shocking. I am not that kind of person, so I broke up with him. Despite the breakup, he is still constantly texting me, even though I stopped texting him a while back and made it clear I don’t want to see him. The situation hurts me so much, and any help you could offer would be much appreciated.
Joining another couple for erotic fun is not uncommon; many people enjoy it. In fact, there are many communities of people who regularly participate in this sexual style. But it is not for everyone, and jealousies and insecurities can arise no matter how sexually open a person is. “Swinging” is advanced sexual play that requires a couple to be well bonded and requires each partner to be psychologically stable as well as sexually mature.
Rules, transparency, careful negotiation and mutual consent are necessary. In your case, you have been quite clear with your boyfriend that this is not at all to your taste. A caring person would have respected that. Unfortunately, he is not taking “no” for an answer and is trying to coerce you into changing your mind.
Although you are feeling hurt right now, it would be best if you followed your intuition and stayed away from him – not because of his particular sexual interests, but because of his insensitivity and bullying. Make sure any future partner is someone who considers that your feelings and values are important.
Pamela Stephenson Connolly is a US-based psychotherapist who specialises in treating sexual disorders.
If you would like advice from Pamela on sexual matters, send us a brief description of your concerns to private.lives@theguardian.com (please don’t send attachments). Submissions are subject to our terms and conditions: see gu.com/letters-terms.
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try now.” Still, as a miscarriage patient, you run up against the dilemma that recurrent miscarriage is not a diagnosis in itself, so the difficulty is in establishing which treatment is most appropriate to you. Even with the help of the most motivated of doctors, there is going to be a degree of trial and error.
Many people will be told, as we were, that the best treatment is no treatment – simply try again. This is what we did, only to miscarry for a fourth time. We were under the supervision of the recurrent-miscarriage clinic, yet even after that fourth loss, the prescription remained the same: just keep trying.
It took us a year before we felt ready to roll the dice again. Shortly after I started researching this piece, in November, I found out I was pregnant for the fifth time.
* * *
To be pregnant again after previous miscarriages is to live at the fork of two alternative lives. You try to think as little as possible about what’s going on inside your body, while, of course, thinking about it all the time. Alive or dead? Baby or miscarriage? In every possible scenario, you plan for the two outcomes. To a certain extent, you are forced to buy into both possibilities simultaneously. You cannot truly believe it will work out, but you have to proceed as though you are pregnant anyway, until a scan proves otherwise. Alive and dead. Schrödinger’s foetus.
You treat yourself as your own walking research study: a sample of one. Perhaps you take a different brand of prenatal vitamin. Or you do different exercise. You do no exercise at all. You drink less caffeine. You drink no caffeine at all. You are more careful. You are less careful, because you’ve been unimpeachably careful before and look where it got you. Mostly, though, you just wait.
Why hasn’t miscarriage medicine moved faster or farther? Why isn’t there more certainty about what works and what doesn’t? The first detailed depictions of a human embryo’s development, from three weeks to four months, were produced by the German anatomist Samuel Thomas Soemmerring in 1799, and the images are remarkably similar to graphics used in week-by-week pregnancy apps today. Yet a precise schema of measurements to date the stages of early pregnancy – between seven and 16 weeks – wasn’t established in modern clinical practice until 1973, with the advent of ultrasound imaging. We had put a man on the moon before we could routinely see, in real time, what was happening inside a woman’s womb.
Pregnancy research, in general, is underfunded. A recent research review, published in January 2020, found that for every £1 spent on pregnancy care in the NHS, less than 1p is spent on pregnancy research. “Compared to other areas – such as infertility – miscarriage has certainly lagged behind,” said Arri Coomarasamy, who sees patients in both fields.
“Miscarriage gets a bad deal,” agreed Hassan Shehata, a consultant obstetrician and gynaecologist, who runs the Centre for Reproductive Immunology and Pregnancy, in Epsom, Surrey. “For a start, there is no specialist training,” he said. When you train as a gynaecologist, you can specialise in sub-fields such as infertility and IVF, but there is no specific speciality in miscarriage, he explained.
There are also practical difficulties to conducting studies. “Pregnancy is difficult to research as, by its nature, studying it might disrupt it,” Nick Macklon told me. This means you’re often left with retrospective population data (easily skewed by multiple factors), or studying donated embryo or foetal tissue (tightly restricted for ethical reasons – and prohibited altogether by “personhood” laws in some parts of the US, which insist on burial or cremation of all pregnancy tissue).
Even when human trials of treatments are feasible, there is the challenge of persuading women who are desperate to avoid another miscarriage to sign up to a study in which they might be given the placebo. As Ippokratis Sarris, a consultant in reproductive medicine and director of King’s Fertility, a private fertility clinic in London, put it: “It’s very difficult to do a proper trial – people want to take something they think might work. How do you tell them they can’t have it until there is good evidence?”
Now that I was pregnant again, there was one treatment I was desperate to try. Progesterone has long been the great hope of miscarriage research. This “pro-gestation” hormone is produced in higher quantities during pregnancy by a woman’s ovaries (and, later on, by the placenta). It is essential throughout pregnancy and helps prepare the womb lining, although scientists don’t yet understand the precise mechanisms by which it does this. In May 2019, a large, multi-centre trial of progesterone, given in early pregnancy – the Prism trial – found that for women with a history of recurrent miscarriage who had started bleeding during their next pregnancy, taking progesterone made a significant difference to the live birth rate, compared with a placebo.
I was prepared to argue the toss for progesterone with my doctors this time around. I knew the new evidence didn’t perfectly fit our circumstances. I wasn’t bleeding in this pregnancy, for one thing. To my surprise, the female doctor we saw at the clinic for our first appointment, in the first month of this pregnancy, agreed to prescribe it without so much as a raised eyebrow. It was not the first time I have asked about some speculative treatment, but it was the first time the clinic had agreed.
As Dan and I joined the queue at the hospital pharmacy, tucked away in a grimy building in Paddington, I felt I was holding on to something bigger than the printed prescription in my hand. For the first time, we had something, after being told that there was nothing.
Then less than a week later, at eight weeks pregnant, I started to bleed.
* * *
There are therapies for miscarriage that have been available privately for well over a decade, yet are no closer to becoming mainstream medicine or available on the NHS. Where questions remain over the evidence, private clinics can go ahead and offer treatment anyway – something the NHS cannot do.
One therapy available at a handful of private clinics – lymphocyte immunisation therapy (LIT), in which a woman is given a transfusion of white blood cells from their male partner before she becomes pregnant – has been banned in the US, outside of a research setting. Such treatments belong to a field known as reproductive immunology, and stem from work in the 80s and 90s by an American obstetrician, Alan Beer, who once summed up his theory in the following way: “Effectively, women become serial killers of their own babies.”
The idea is that miscarriage can be caused by a hyper-vigilant immune system that misrecognises the symptoms of pregnancy as a threat. In these cases, treatment may involve suppressing the immune system using steroids or intralipids (essentially an emulsion of soybean oil and egg yolk, given intravenously, sometimes referred to as the “mayonnaise” or “egg-yolk” drip). Clinics charge up to £50,000 for such treatments. However, all but one of the experts I spoke to expressed scepticism about their effectiveness.
Funding high-quality trials is particularly difficult when it comes to treatments that target the immune system, because, according to Quenby, in the past there has been a tendency to overhype the results.
Quenby believes our understanding of miscarriage would improve if we considered it as a public health issue, as we do stillbirth and neonatal deaths. Both of these are more common where there are high levels of social deprivation, and it’s likely the same is true of miscarriage rates, too. Though, currently, hospital trusts are not required to report the rate in their area.
But like periods, female pain, the menopause and conditions such as endometriosis, which also want for good research and understanding, it’s hard not to conclude that miscarriage suffers from a lack of knowledge and interest because it happens to female bodies. What’s more, the underlying assumption tends to be that miscarriage is always down to something a woman’s body is or isn’t doing.
In 2019, researchers at Imperial College London found that partners of women who have had three or more miscarriages tend to have higher levels of damage to their sperm’s DNA. The trial was small, comparing the sperm of 50 men whose partners had had miscarriages with 60 men whose partners had not. The results will need to be replicated. And before any possible treatments can be trialled, researchers need to establish what causes such DNA damage.
Still, Quenby said, “The fact that we’re even looking at it is really important.” Traditionally, men and their contribution to the pregnancy have been largely left out of the picture. In the past three years, while I have been scanned and probed and pricked for multiple phials of blood, aside from completing a form outlining his basic medical history when we were referred to the recurrent-miscarriage clinic, Dan has not been required to so much as cough and say “ah”.
* * *
When I discovered I was bleeding, I did a desperate search online for answers. I decided I was either having my fifth miscarriage – or, just possibly, the intermittent, brownish spotting was a side effect of the progesterone. I knew I should phone the recurrent miscarriage clinic, or my GP, or try to get an appointment for a scan at my nearest early pregnancy unit. But I couldn’t bear to. I was not ready to talk practicalities just yet, and there was no one at the clinic to call for the sake of talking. Besides, we were due to go back for a scan the following week.
In the following days, the bleeding didn’t stop, but it didn’t get worse, either. Even so, I couldn’t shake the thought that, at eight weeks pregnant, this was the exact same point I had miscarried the last three times. Dan and
I made our contingencies. It was early December, and we were due to move house in a few days, and we discussed how we would fit surgery around the move, if it turned out to be bad news. I bought sanitary pads and wine. We pretended we were sanguine. We pretended we knew how we would cope. “We’re pros now,” we joked. I barely slept the night before the appointment.
On 4 December, my mum came with us to the hospital and managed to keep up a steady patter about her cycling, her knitting and the roadworks on the A14 while we waited. I knew she wanted to distract me. But the only words my brain had space for were the ones I was convinced I was about to hear for a fifth time: I’m so sorry there is no heartbeat. I’m so sorry there is no heartbeat.
When we were finally called in for the scan, I explained to the sonographer that I was anxious. That I’d been bleeding. I tried not to look at the print on the wall of the room – the same room we were in last time – of a red heart, printed in swirly fauxbrushstrokes. I tried not to think what I thought last time: how fucking inappropriate that is. A heart, for when there is no heartbeat.
I lay down on the bed and unbuttoned my jeans. Dan held my hand. I was braced for the words: So sorry. So sorry. Except they didn’t come. The sonographer was telling us that everything looked fine. She turned the screen towards us, and she was pointing out the flickering heartbeat. She was telling us that I was measuring in at nine weeks and one day. The baby wasmoving. And I was crying.
* * *
Did I dare to believe that the progesterone was actually working? The possibility loomed in my mind that our miscarriages really had been “just” bad luck all along. At least one of our losses was down to a chromosomal abnormality known as a triploidy: essentially an extra set of chromosomes. One cause of this is an egg being fertilised by two sperm at once – as random and unavoidable as that.
About two weeks after it started, the bleeding waned and our clinic suggested it was time we transferred to our local hospital for antenatal care and the 12-week dating scan. (This is normally the first scan people have on the NHS, at the end of the first trimester, and it’s used to check the foetus’s health and estimate the due date.) On the one hand, this felt like an achievement – we had never made it this far before – but on the other, it meant leaving the relative security of the specialist clinic, where everyone understands why you don’t want to think further ahead than the next appointment.
Feeling like fledglings pushed from the nest, we had to brave the official NHS booking-in appointment, which involved giving our medical histories to the local midwifery team and some routine screening tests. We have done this twice before, during previous pregnancies, when we knew and worried less. Two days after the second one, I bled out the tiny embryo on our bed at home. I hadn’t dared make this particular appointment since.
We got our all-important appointment for the dating scan, a little over two weeks away – delayed slightly by the Christmas break. Time passed twitchily. We congratulated ourselves for not miscarrying on Christmas Eve, on Christmas Day, on Boxing Day.
On 30 December, six hours before the scan, I read a note from the hospital that said you have to pay £5 for a copy of the scan photo. Fleetingly, I debated getting some cash out, but decided this would be jinxing things. At the hospital, I squeaked my name to the receptionist. We were early. This may have been our 12-week scan, but it had taken us 48 weeks of pregnancy to get here. I really wasn’t sure if I could wait another 20 minutes.
I had my spiel prepared for the sonographer – “a bit anxious” … “four miscarriages”.
“Thank you for telling me,” she said, as I lay down. There was the briefest of pauses. “OK, here’s your baby.”
Whereas in previous pregnancies there had only been cavernous blackness on the ultrasound monitor, now there was wobbling movement; the grey outline of a head and a tiny, round tummy – a waving, wondrous sea creature emerging from the dark.
“They’re a wriggler,” the sonographer told us, smiling. I gripped Dan’s hand and we watched as the baby – I will try to call it a baby from now on – somersaulted for us. For the first time, we left an antenatal unit with a scan photo and stepped out into entirely new territory.
On 14 March, we hit 24 weeks, which is deemed the point of “viability” – that is, when a foetus is theoretically capable of surviving outside the womb. Whatever was going to happen to us from now on, it would not be classified as a miscarriage. Keeping this baby alive would no longer be down to my body alone. Should anything happen, doctors would have to at least try to intervene. These were not comforting thoughts exactly, but they were something.
Ten days later, the whole of the UK went into coronavirus lockdown. The weekend we had quietly celebrated reaching viability also turned out to be the last weekend I would see anyone but my husband or a healthcare professional for a long time.
* * *
The initial days of confinement were softened by activity and preparation: batch-cooking, arranging deliveries, cancelling plans. I comforted myself by reading the official Covid-19 guidance from the Royal College of Obstetricians and Gynaecologists over and over: “There is no evidence to suggest an increased risk of miscarriage … Pregnant women are still no more likely to contract coronavirus than the general population.”
Slowly, though, as I watched the number of reported cases and deaths rise, marooned on the sofa at home, fear seeped under the door. Not a day has gone by, since finding out I was pregnant again, that I have not worried that my baby might die. But now, during a global pandemic, those nebulous anxieties hardened into something nameable. The shadow on the nursery wall had taken a solid shape.
I woke up one night in the first week of lockdown feeling hot, my throat tight. This is it, I thought – I’ve caught it. I had barely been outside for a fortnight, though I did get my hair cut a few days before lockdown was declared. And so the taunt went round and around in my head, as I stared at the ceiling unable to sleep: your baby could die, and all for the sake of your split ends. In the rational light of day (and feeling fine), I concluded it had probably been heartburn.
The world shrank. I baked bread and planted herbs. I silenced notifications and deleted social media accounts from
my phone. I tracked my daily steps and counted my baby’s kicks using an app. Mixed in with the fear and stress of uncertainty, there was also a guilty kind of sadness for the things I would not get to do – things I had dreamed of for so long: a “last” holiday as a couple, showing off my bump in my first maternity dress, meeting new “mum friends” for coffee.
People phoned to ask how we were coping, but it felt selfish to admit to such small sadnesses, when there were bigger worries: for my brother, who had to postpone his wedding; for my cousin, who is a nurse; for our four grandmothers, who all live alone. Then there were the worries of people I don’t know, but who could so easily have been us: those who have had their fertility treatment cancelled, or who will be told they have miscarried during scan appointments they have had to attend alone, in order to protect other patients and NHS staff. At the time of writing, hospitals were being advised not to offer extra scans in early pregnancy, even for people with a history of miscarriages.
On 17 April, week four of lockdown, I attended an appointment for a 28week routine growth scan by myself, while Dan, following the new rules, waited in the car. A security guard at the door checked my name off a list. The sonographer and midwife I saw wore masks and visors, while the doctor conducted my appointment from the opposite end of the consulting room. I projected my voice, like a bad stage actor: “No, no family history of diabetes”, and so on.
On some days, it has felt as though the pandemic has brought my experience of pregnancy closer to the curve of normality. For so long, I had felt as if I was only playing at pregnancy, like a small girl with a cushion up her jumper. I couldn’t trust that I would get to do things other pregnant women take for granted. But then, suddenly, no one else was going to antenatal classes, throwing baby showers or browsing department stores for the perfect pram either.
The temptation, when you get to where we are now, still pregnant after so many losses – and in the shadow of loss on a global scale – is to start talking about miracles. But I don’t believe in miracle babies any more. I believe we should be able to put our faith in the evidence, in knowledge of how our bodies work – or don’t work. That waiting and hoping isn’t enough. Even so, as I sit here, in my fifth pregnancy, in the third trimester, wearing my very first pair of maternity jeans, feeling our baby kick inside me, it is hard not to consider it a wonder that any of us gets to be here at all. Especially when there is still so much we don’t know.
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