"Making the child mine": Mothers' thoughts and feelings about the mother-infant relationship in egg donation families.

Interviews and Analysis

Each mother took part in a qualitative interview conducted by one of two researchers in the family home. The first section of the interview comprised the Parent Development Interview (PDI; Aber, Slade, Berger, Bresgi, & Kaplan, 1985 ; Slade, Belsky, Aber, & Phelps, 1999 ). The PDI is derived from attachment theory and is a semistructured interview that explores parents’ representations of the parent–child relationship and is based on the idea that parents’ thoughts and feelings about their child influence their parenting. Parents are asked to describe their own and their child’s experiences in moments of relatedness and interaction. The PDI has been used previously with both egg donation ( Golombok et al., 2005 ) and adoptive samples ( Steele et al., 2008 ). The second section of the interview related to experiences of fertility treatment and egg donation. Participants were asked about their fertility treatment history (including how long they had been trying to conceive, their reasons for using fertility treatment, and the type[s] of treatment attempted), and their experiences of egg donation (including the type of egg donation chosen, reasons for, and thoughts about, this and their feelings prior to treatment). The format of these questions was drawn partly from previous studies of egg donation parents ( Golombok et al., 2004 ), and partly from the existing egg donation literature. Both sections of the interview were semistructured, allowing interviewers to include probes where necessary. All interviews were audio recorded. Both sections of the interviews were transcribed verbatim, pseudonyms were used to protect participants’ anonymity, and all identifying information was removed from the transcripts. Interview transcripts varied in length (3,837–14,143 words).

Data were analyzed according to the principles of thematic analysis described by Braun and Clarke (2006) and thematic networks ( Attride-Stirling, 2001 ). Data analysis was carried out by the first author. The analyses followed an inductive, data-driven approach, in that initial analyses of the dataset were undertaken without the use of a predetermined coding scheme, meaning that the themes identified are strongly linked to the data themselves. The analysis consisted of a systematic, phased process, including familiarization with the data where all transcripts were read and reread, memo writing, and coding. All parts of participants’ talk (from both sections of the interview) that discussed the mother–infant relationship or experiences of egg donation were coded. After initial coding, all coded data extracts were collated, and codes were sorted into themes. Themes were assessed for internal homogeneity and external heterogeneity and were refined to produce one global theme, eight organizing themes, and five basic themes ( Attride-Stirling, 2001 ). Peer debriefing was undertaken during the process of theme refinement to ensure that the final thematic map was reflective of the dataset in its entirety.

Gaskell and Bauer’s (2000) two broad criteria of confidence and relevance were adhered to in the design of the study, data collection, data analysis and presentation of the results in order to ensure the quality of the research. Confidence and relevance criteria are based on the principles of evidence-based claims-making and public accountability. Confidence markers “allow the reader and receiver of research to be ‘confident’ that the results of the research represent ‘reality’” ( Gaskell & Bauer, 2000 , p.344), and relevance markers scrutinize “the import of the research evidence for the people involved, for the theory or concepts at stake, or for the purposes of the research project” ( Gaskell & Bauer, 2000 , p.363).

Written informed consent was obtained from all study participants, and ethical approval was obtained from the University of Cambridge Psychology Research Ethics Committee.

Results

Egg donation mothers’ representations of their relationship with their infant, and the significance attributed to egg donation in the mother–infant relationship, could be understood in relation to one global theme “making the child mine” and eight organizing themes: (a) preconception strategies, (b) importance of pregnancy, (c) establishing a bond, (d) child as wanted, (e) mother’s influence beyond genetics, (f) physical resemblance, (g) managing reminders of egg donation, and (h) finding a place for the donor. Two of the organizing themes (preconception strategies and managing reminders of egg donation) comprised several basic themes. The theme “preconception strategies” comprised (a) decisions about donation type, (b) minimization of the donor’s contribution, and (c) normalization of family diversity, and “managing reminders of egg donation” comprised (a) comments about the child’s appearance, and (b) other reminders. All themes are described in detail below, with illustrative quotations throughout.

Egg donation mothers used a variety of strategies that appeared to facilitate the process of helping them to feel that the baby was their own, in other words “making the child mine.” This was an ongoing process, which began before conception and continued throughout infancy, with strategies used to greater or lesser extents by different women.

For most mothers the strategies were successful, in that they consistently reported that the infant was “my” child and “feels like mine.” Many women emphasized that they felt they could not love their baby more, “I don’t think I could love him any more if he was completely my genetic material” (Grace). A small number of women, however, described still struggling with the idea that their child was not genetically related to them, “Biologically they’re not my children, even though I was pregnant with them and I gave birth to them, and that’s still quite a hard thing for me to square in my own mind” (Wendy). For several mothers this was expressed in terms of an ongoing, although not overwhelming, sadness when they thought about the relationship, “It still saddens me to think that he’s not, you know, genetically related to me” (Claudia).

For many women the process of making the child their own began before conception: in their decision making about donation type, their minimization of the donor’s contribution, and/or their normalizing discourses around family diversity.

Most women stated a preference for using a donor who was unknown to them at the time of treatment, and many felt that this helped them establish their identity as the child’s only mother by creating more explicit emotional and practical boundaries between their family and the donor, “I think it comes down to that sense of being able to fully own the identity of being the child’s parent” (Eve). Mothers expressed concerns that a known donor could pose a threat to their maternal identity by the donor potentially feeling they had “a stake in [the child]’s upbringing” and by interfering in their parenting by “looking at you or disapproving of the way you were bringing up the child” (Carla). Conversely, for women who used a family member as a donor, the genetic connection between mother and infant was viewed as comforting, “I think both of us thought it would be lovely to have a child who is genetically related to both of us” (Lynda). For these mothers, intrafamily donation enhanced the sense of the child “belonging” in the family through the presence of shared characteristics and physical similarities, “it was great my sister did it because I know [child] will have some of her, my family characteristics, and looks and things like that, so that was important to me” (Lisa).

Minimization of the donor’s contribution

For some women, minimization of the donor’s contribution also helped them to claim the child as their own. Often this began before conception but could be used as an ongoing strategy and was seen in mothers’ language when discussing the donation. Some made comparisons with other medical procedures, “It’s only like someone giving you blood” (Christina), or stressed the small size of the donation, “a tiny egg is not really that much of a big deal” (Tanya). A clear distinction was drawn between an egg and a baby: “It was a medical process, it was a donation of tissues essentially, you don’t donate a little mini baby” (Della). For women using known donation, it was important that the donor shared this conceptualization of the egg and was also able to minimize their contribution, “I needed her to say to me that ‘this is all I’m doing, there’s no emotion there, there’s no nothing, it’s not as if I’m giving you my two-year old daughter, I’m literally giving you an egg, that’s it’” (Adele).

Normalization of family diversity

Some women used examples of different family relationships and structures to normalize the absence of genetic connections between family members, instead emphasizing family as predicated on shared experiences. Women used examples of half-siblings, step-siblings and adoptive relationships to illustrate the point:

I’ve got a half-brother who’s been brought up separate to me and I haven’t got the same ties with him. . . . I’ve got stepbrothers and sisters. . . . I probably feel a bit closer to them in some respects than I do him because I’ve got memories with them (Rose).

Other women suggested that the concept of family was changing, “I just think families look totally different now” (Aileen), highlighting that assisted reproduction was becoming more common.

For some women, egg donation provoked few concerns and they felt certain prior to conception that it would not make a difference to how they thought or felt about their child, “It wasn’t a big life-changing decision, I was happy to have children whatever way because we wanted a family” (Lily).

Importance of pregnancy

For many women, pregnancy was a period during which they had been particularly conscious of the nongenetic relationship. Mothers described feeling uncertain about how they would feel about the baby when it was born, how the baby would feel toward them, and/or what the baby might look like. The extent of these uncertainties varied between women, with several describing “fears” and “panics”, others “worries” and “concerns”, and some never thinking about egg donation while pregnant.

For women who experienced uncertainty about how they would feel about the baby, these feelings centered on whether the child would feel like “my child,” “My only concerns were . . . how was I going to feel about him when he arrived . . . whether I would feel like he was mine” (Florence) and “I was worried that when he was born I would look at him and think he was someone else’s baby” (Hannah). A related concern for some women during pregnancy was whether or not they would be able to bond with the baby, “That’s all I thought about before he arrived, I was just like oh, what if we don’t bond?” (Maggie). Several women had also worried about whether or not the baby would feel able to bond with them, “That was my whole preoccupation . . . would I bond with this baby, would this baby bond with me? My biggest fear was that this baby would think—who the hell are you?” (Leah).

Others described worries around the uncertainty of what, or whom, the baby would look like, expressing concern that they had less control over this aspect than in natural conception:

I didn’t know who she was going to look like. I think when you have a baby naturally . . . like when my niece was born . . . she looks like me, so I think that was the thing I struggled with most . . . if she doesn’t look . . . what am I going to do then? (Gabi).

Despite these concerns, most mothers discussed the central role pregnancy played in conferring ownership of the child, “As far as I’m concerned she was inside of me and so she’s my baby” (Catherine). For many women the idea that during pregnancy they contributed physically to the baby’s development also helped them to feel that the baby was theirs, with mothers often speaking about their role in “nurturing” and “growing” the baby. As one mother said:

Ok, his DNA isn’t mine, but I’ve grown him since he was a 3-day-old embryo so it’s my blood running through his, I’ve fed him, I’ve nurtured him, I’ve grown him, it’s my heartbeat he heard when he was inside me, it’s me he’s going to call mum (Della).

Establishing a bond

Establishing a bond with the baby was an important process in the early mother–infant relationship and played a crucial role for many women in enabling them to feel that the child was their own. Although most mothers described feeling a “close”, “strong,” or “loving” bond with their infant, establishing a bond was individual to each mother and occurred at different time points. Several mothers spoke about loving their child from conception or when learning that they were pregnant. Others described bonding during pregnancy, “I felt I really bonded with him when he was in the womb” (Alice). For some women, birth was the point at which they felt they established a connection with their child, “I just loved him unconditionally as soon as he was born” (Nina). For other women, establishing a bond with their child happened during infancy.

Although most women reported no difficulties bonding with their baby, a minority experienced challenges establishing a bond, and attributed this specifically to having used egg donation. For several women, this difficulty was experienced, and resolved, during pregnancy. One mother described finding the first half of her pregnancy challenging:

It was very, very difficult, perhaps for the first good 20 odd weeks. . . . I was angry that I’d managed to get pregnant so easily with someone else’s but not my own, and when people say “oh you must be delighted” it was like. . . . I am, but I’m also very, very sad because I’m still grieving for the fact that I can’t have my own kids (Sophie).

For this mother, feeling able to bond with her baby was not possible until later in the pregnancy when she felt that he had his own personality:

It was later when me and the baby bonded, when he was moving and kicking . . . you could poke him and kick back . . . so you’d have this little game, and that’s when . . . he had a personality, he was a real thing, and that’s when I was like ok, this is my baby.

Several mothers struggled to bond during the early months of infancy and attributed this to concerns about egg donation, despite also acknowledging the difficulty of disentangling the extent to which these problems were compounded by the common challenges of early parenthood:

I really, really did struggle because she was a very colicky baby as well. . . . I had my own lingering doubt about whether I’d done the right thing about using donor eggs and everything . . . certainly in that first few months, I think it did cause a certain amount of emotional separation, on my part. . . . I really couldn’t give myself a hundred percent to her, emotionally. I took care of her, I did what I needed to do, but I didn’t feel like she was my child really. It took a while I think for that feeling to come in (Daisy).

Child as wanted

Many mothers’ representations of their baby and of the mother–infant relationship emphasized how wanted the baby was. This was often discussed with reference to how long the couple had waited to have a child and how precious the baby was as a result, thus establishing the central position the child occupied within the family. Babies were often referred to as a “miracle” and “special,” with one mother describing her daughter as “the love of my life. A miracle really. I never thought we were going to have a child so . . . just the best thing that’s ever happened to me” (Megan).

A related narrative used by some mothers, which also served to establish the child within the family, was the belief that had they chosen a different route to parenthood, or been successful on a different treatment cycle, they would not have been a mother to this specific child. For some mothers, this idea was framed in terms of “fate” and that having this child was “meant to be.” In some cases, this fatalistic belief was expressed when mothers talked about the decision to try egg donation; in others, it was used in relation to choosing the right donor. Some described a sense of “knowing” that the treatment would work, “I just knew I was going to get pregnant . . . I just knew it in my heart. It was a very strange feeling” (Gloria), knowing that the pregnancy would be successful, “I felt that this one was going to be different” (Madeline), or knowing that they had ended up with the “right” child, “I’m a big believer in fate, what’s meant to be is meant to be, and we’ve got the right one cos she’s ours” (Katy).

Mothers’ influence beyond genetics

One of the ongoing ways in which mothers made the child their own was through emphasizing their contribution to the child’s development through the quality of the mother–infant relationship. Most women spoke about their ability to influence their baby’s personality, development, values and interests through their own behavior and interactions:

I’m hoping she’s quite an extrovert, outgoing little girl, because. . . . I’m not a quiet mum with her. . . . I think I’m quite boisterous with her and quite. . . . I’m all colors of the rainbow with her and I do lots with her. . . . So I do believe you do influence that (Mary).

Highlighting shared mannerisms was another common way in which mothers identified their influence on the child’s development, “His mannerisms are turning out to be the same as me . . . he copies me a lot and I didn’t realize that I gave him a lot of kisses and now he’s started kissing people all the time” (Lucy).

Many mothers proposed a definition of parenting in which commitment and effort mattered more than genetics, “ [the eggs] could come from somebody who’s educated at Cambridge, a member of Mensa, but if you don’t put in the effort with your children it doesn’t matter” (Maggie). Providing consistent care was believed to be particularly important as it enabled the mother and baby to build a relationship that would sustain into the future and be more influential than a genetic connection. Most mothers were able to see that their efforts were recognized by the baby and could be seen in their baby’s responses. One mother described feeling reassured by her son indicating that he wanted her to be the one who comforted him:

If he wakes up in the night . . . it’s always me that he wants . . . it’s really nice, ‘cos I suppose again . . . with the egg donation thing . . . obviously when sort of those moments happen, it does sort of make you feel, actually yeah . . . it doesn’t matter what the background is or whatever. You’ve been there all the time for him, and he obviously recognizes that (Amanda).