“One of the biggest things that women talk about when they have gone through pregnancy loss and become pregnant afterward,” says Rachi Hain, founder of Merkaz Panim (www.merkazpanim-fertility.org.il), “is not just that they are going to be stressed during the pregnancy. They are afraid that no one will understand why they are stressed.”
Hain, a social worker, founded Merkaz Panim in 2011 to provide emotional understanding and physical support to women and couples facing fertility challenges. She traces her interest in the field to her own fertility issues she experienced shortly after marriage. While the problem was quickly resolved, Hain’s experiences visiting fertility clinics and the lack of emotional support that couples received during fertility treatments made an impression.
“This occurred at the same time I had finished social work school, and my eyes were open,” she recalls. “I was looking around me with the question that you learn in social work school – ‘Ma shlomech – ‘How are you doing?’ Even though my problem was resolved quickly, I still had to go to the clinics. One of the things that struck me was as nice as the staff was, and as much as I felt that they did care, I felt that people were collapsing. You would see people crying, and you would see people experiencing stress. You would see wives fighting with their husbands, and there wasn’t enough of an emotional support system there.”
Limited emotional support
Hain adds that the limited emotional support is understandable, given that people go to the doctor to receive medical treatment for their physical ailments. This is especially true for the large numbers of people who attend fertility clinics. Nevertheless, she says, “There wasn’t any time for people to stop and see how you were doing. I felt like people said ‘Ma shlomech – ‘How are you doing?’ but weren’t really available for the answer. Fertility clinics are addressing the physical part, but it is a really hard emotional piece as well.”
People are understandably reticent about issues surrounding fertility, she adds, and that if someone in the clinic saw someone they knew, they would run to the opposite end of the waiting room to hide because being in a fertility clinic can be very exposing. “In a Jerusalem waiting room, you’re going to see everyone you know,” she concludes.
Hain, whose own fertility issues had been treated by staff affiliated with the Puah Institute, which assists Jewish couples in addressing fertility issues in accordance with Halacha, approached the organization and proposed to become the agency’s in-house social worker. Instead, they suggested she become their representative at the IVF clinic in Jerusalem’s since-closed Bikur Cholim Hospital. Hain worked at the hospital for several years and credits Chemda Nueman, the hospital’s head nurse at the IVF clinic, and Dr. Irit Kafka, an OB-GYN doctor and fertility specialist there, with providing her with the medical information that was necessary to provide emotional assistance to couples experiencing fertility issues.
“One of the big things about providing emotional care to people going through any kind of medical intervention,” explains Hain, “is that you need to know the medical intervention. There are questions that go along with the medical intervention that you know how to ask only if you know what it entails. You can’t give full care if you don’t understand the full story. I made it my business to understand the medical journey.” Hain hastens to add that she is not a doctor or a nurse and does not provide medical advice.
After working at Bikur Cholim, Hain concluded that there was a need for a nonprofit center that could provide affordable and subsidized care to offer emotional support for people dealing with fertility issues. In February 2011, Hain opened Merkaz Panim, which initially ran a pilot project with Bikur Cholim, Hadassah-University Medical Center on Jerusalem’s Mount Scopus and the Puah Institute that referred clients undergoing fertility treatments to the center. Clients met with therapists and social workers to discuss their emotional issues and also received physical treatments of massage, shiatsu or yoga.
Doors open to the general public
The pilot proved to be a success, and shortly thereafter, Merkaz Panim opened its doors to the general public. Today, the center, which is located in the German Colony, works with three main populations:
- Couples who want to have a baby who are undergoing medical treatment such as hormonal therapy, IUI (intrauterine insemination), IVF (in vitro fertilization), egg donation, sperm donation, and surrogacy, and PGD (preimplantation genetic diagnosis). In addition, couples who have not yet begun infertility treatment or know they will be unable to have children, come for therapy.
- Couples undergoing or who have undergone pregnancy loss, which includes miscarriage, stillbirth or cases when the baby lived for a few moments after birth, or pregnancy termination, usually due to genetic problems.
- Couples that are in the midst of a pregnancy after a stillbirth or multiple miscarriages.
Social workers at Merkaz Panim meet with clients to discuss their situation. Hain says that treatment allows clients to be heard and understood and unload their emotional issues. In addition, therapists provide tools that enable patients to go through the process with their partners in a way that is not as difficult and to communicate their various needs while facing the difficulties of the process.
Hain points out that men and women experience the difficulties of fertility treatments differently. In the early days of Merkaz Panim, she says, “Husbands would come in and say, ‘How can I help my wife get through this?’ Now there is a lot more focus on how they themselves are doing. The more both people can be supportive of each other, the more strength they have. We always ask the couple to come together at least once.” She reports that today, men also come to the clinic by themselves.
In addition to providing therapy, the center offers shiatsu, yoga and massage treatments. Hain explains that fertility treatments are often invasive, uncomfortable and unpleasant. “People often feel that their bodies have failed them,” she says, “and while they are eager to undergo treatment to reach their goal, it is not physically easy.” The treatments, says Hain, are a way for clients to meet their bodies in a different way and place.
“Most of the people who come want talk therapy,” says Hain. Clients who are undergoing fertility treatments come for seven sessions, though they can continue coming for additional sessions. Often, the couple will come from time to time, while the women come alone regularly. Couples who have experienced pregnancy loss, says Hain, come together for a number of sessions.
Hain explains the origin of the name Merkaz Panim. One of the meanings of the Hebrew word panim is “face.” “When I was working in Bikur Cholim Hospital,” she says, “I would hear women say, ‘They are not looking at me in the face (‘ba’panim’). I’m just another body on the conveyor belt, and it’s just a medical process.” Merkaz Panim attempts to look clients directly in the eye and help them with their needs.
"We are a very baby-focused society, and it is normal to feel pain about it when it is not happening. You are not only worthwhile if you are pregnant or when you have a baby."
Rachi Hain
She adds that the name has nothing to do with babies. “We realize that people here for fertility treatments want to have a baby,” says Hain. But the focus is on how you are getting through this journey and how you are living in the here and now. You have worth in the here and now, to get from the world and to give to the world. It’s easy to forget to take care of yourself and forget your own self-worth. We are a very baby-focused society, and it is normal to feel pain about it when it is not happening. You are not only worthwhile if you are pregnant or when you have a baby.”
Hain suggests that, in general, people need to be respectful when others are experiencing fertility issues and how much they are choosing to share. “We don’t have to be mastermind psychologists to be there for someone. Just a simple ‘How are you doing?’ or ‘I care’ or ‘I don’t know how to respond to this. Help me understand better so I can be there for you’ is sufficient.”
When presenting at a hospital staff meeting, Hain recalls that a young doctor told her, “I do D&Cs [a surgical procedure to remove tissue from inside the uterus after a miscarriage or abortion] for women all day long, and I don’t know what to say, so I don’t say anything.” Hain replied, “I think you should say, ‘I’m sorry,’ just to connect to the human piece to say something simple and true.’”
Hain advises that family and friends should be inclusive to family members experiencing fertility difficulties and suggests that they need to be addressed as people rather than by the number of children they have. “We need to make sure that we are not leaving the person out and to make sure that they are feeling worthwhile in the here and now. They don’t have a baby, but they are still part of the family. People who don’t have children don’t feel they have a place in the community. We need to make sure they have that place.”
The world, and the Israeli scene, in particular, says Hain, has become much more oriented to how people are doing in mind as well as in body, with an awareness that the struggle to have children is an emotional journey as well as a physical journey. Ten or 20 years ago, she reports, there was much less awareness of how much an emotional journey it is. Today, 11 years after its founding, Merkaz Panim continues to give a face to the emotional distress and tension of those experiencing fertility issues.