tokophobia: fear of childbirth

[Saffron]

The Royal College of Midwives has been campaigning for an increase in the number of midwives so that they can meet the demand for one-to-one midwifery care in maternity units.

Simon Mehigan acknowledges that this could transform many women's experiences.

"Every unit is facing the challenge of how to manage women in early labour, when they are in pain but not actually in labour. Having one-to-one care would make all the difference."

http://www.bbc.co.uk/news/health-20348463

[Saila]

I was absolutely dreading my first birth. Really scared. I would have loved a c-section.

The labour I had was awful. I hated it and it traumatised me.

It was 'natural' birth with gas and air and I found it fking awful

(Sorry about the language)

I've been offered a section for my second, cos of my bad experience, but the pros and cons just don't add up, in the way it does for your first

I wish I had been offered a section first time around. I'd have jumped at it and prob wouldn't have had the slow mental and physical recovery which I suffered from my natural birth.

[Saffron]

It seems to me that there is a (false) sense of saving money or services by trying to shoehorn women into a one-size-fits all experience for labour and birth. In contrast, I think the stress caused by not providing adequate support, especially to first time mothers, could well result in poor birth outcomes leading to less cost-effective outcomes overall. Surely giving women more control, in the form of more choice, would not be more expensive than treating women for poor birthing outcomes resulting from distress in labour and birth.

[Saffron]

Saila, were you offered a chance to review your experience with the midwife or labour team the first time around? Did you ask for a c-section, and were turned down? What other support were you offered?

[Saila]

I was never offered a c-section first time around. If it was affordable privately, I would have jumped at it.

I have had lots of support this time around and have been through my experience at length with senior ppl at kings who agree it was a dreadful experience.

If I had my time again, there would be no contest -

I'm genuinely envious of those who get c-sections

ETA: I was told at the time that you had to have a medical reason to get a c-section.

[midivydale]

I second this, I still feel very raw about my birth despite councelling. I so wish that I had been informed beforehand and I too would have jumped on the chance of a c-section and paid privately if that had been an option.

I cant contemplate a number two as I am not able to get past the thoughts of the birth.

I went into labour with a lavender spray and hypnocd and came out a deeply traumatised woman. It makes me teary even writing this 9 mnths on.

I felt angry and let down by the 'sisterhood' as i felt someone should have told me how awful it can be. But then before you go through it, it is just words isnt it. Its the same with sleepdeprivation, until you are there it is just a word.

I was in kings for a nearly a week with high blood pressure and no one made the connection that it could have been related to the stress i felt after the birth.

Lavenderspray?!?!

I know mine was what is described as a birth with "complications" but I am angry that there is this propoganda that a "natural birh" is always better.

Natural? There was nothing natural about it, i was savaged and still violated.

Oh dear- i am sorry for rambling. It makes me sad that i wasnt prepared for the trauma, feelings and painful recovery as i had been told that it all passes as soon as you have your baby.

I had a highly unrealistic view of water, breathing and lavenderspray, followed by this rush of the deepest love i had ever felt.

No no no no no. None of the above

Oh dear i am rambling again. I just feel very raw about it.

Can you insist on a c-section for your second.

[Lochie]

Midivydale this should help:

http://www.nhs.uk/news/2011/10October/Pages/draft-nice-guidelines-elective-caesareans.aspx

[Saffron]

Saila Wrote:

-------------------------------------------------------

> I was never offered a c-section first time around.

> If it was affordable privately, I would have

> jumped at it.

>

> I have had lots of support this time around and

> have been through my experience at length with

> senior ppl at kings who agree it was a dreadful

> experience.

>

> If I had my time again, there would be no contest

> -

> I'm genuinely envious of those who get c-sections

>

> ETA: I was told at the time that you had to have a

> medical reason to get a c-section.

Oh no, that's awful! Actually tokophobia IS a medical reason, the medical establishment has just been slow to recognise it.

[Saffron]

midivydale Wrote:

-------------------------------------------------------

> I second this, I still feel very raw about my

> birth despite councelling.

Midivydale, were you offered counselling through the NHS. Was it specialised, and how long did you have to wait? I ask b/c I had a straightforward natural birth with my daughter, but suffered severe postpartum depression to the point of having suicidal ideations. I was told the wait for NHS counselling was 14 weeks, and it would be general counselling, not even specialised for postpartum issues. As shocking as that sounds, I have recently learned that even in the case of traumatic births (including perinatal death of the infant), counselling may not be available for up to 6 months!

> I so wish that I had

> been informed beforehand and I too would have

> jumped on the chance of a c-section and paid

> privately if that had been an option.

> I cant contemplate a number two as I am not able

> to get past the thoughts of the birth.

>

> I went into labour with a lavender spray and

> hypnocd and came out a deeply traumatised woman.

> It makes me teary even writing this 9 mnths on.

> I felt angry and let down by the 'sisterhood' as i

> felt someone should have told me how awful it can

> be. But then before you go through it, it is just

> words isnt it. Its the same with sleepdeprivation,

> until you are there it is just a word.

>

> I was in kings for a nearly a week with high blood

> pressure and no one made the connection that it

> could have been related to the stress i felt after

> the birth.

> Lavenderspray?!?!

>

> I know mine was what is described as a birth with

> "complications" but I am angry that there is this

> propoganda that a "natural birh" is always

> better.

> Natural? There was nothing natural about it, i was

> savaged and still violated.

>

Of course natural births are only better if they're uncomplicated. As complicated natural births can lead to lots of medical intervention, including c-section, the argument almost becomes circular at this point.

> Oh dear- i am sorry for rambling. It makes me sad

> that i wasnt prepared for the trauma, feelings and

> painful recovery as i had been told that it all

> passes as soon as you have your baby.

>

> I had a highly unrealistic view of water,

> breathing and lavenderspray, followed by this rush

> of the deepest love i had ever felt.

> No no no no no. None of the above

>

> Oh dear i am rambling again. I just feel very raw

> about it.

> Can you insist on a c-section for your second.

Everyone wants an uncomplicated pregnancy from start to finish, but that's not going to be a reality for everyone. It seems to me that one of the problems with pregnancy and birth is assessment of risk, particularly in first time pregnancies. Improving risk assessment (including accounting for mental factors such as tokophobia) in pregnancy would lead to better outcomes overall, IMHO. Indeed recent research of specific risk assessment associated with perinatal deaths has resulted in a significant fall in perinatal deaths in the study group. Surely if this type of intensive risk assessment, and risk assessment training, were applied to other outcomes of pregnancy and birth, improvements could be made.

With the NHS's recent mandate to provide better perinatal care, I hope that we'll start to see improvements. But at the same time the cynic in me wonders if it will take more grassroots pressure to get it moving?

[Saila]

Personally I don't think my fear was/is irrational. All you need to do is sit in kings labour ward and hear the screams to understand the reality of childbirth

[Jo'sEnglish]

Apologies if this is a long post! Also, I gave birth at Lewisham, not at Kings like most people on here.

Saffron, I saw a woman's health counsellor maybe 3-4months after giving birth. I could have seen her sooner but no one told me about her until my lovely women's health physio advised me to call her. Once I called her I had an appointment in maybe 2 weeks. I'm sure the reason it was quick to get an appointment was that they don't seem to make her existence widely available! I saw her for a few months and she has advised me if I were to even start thinking about trying for another baby I should go back and see her and she will basically work on my behalf to make sure I have access to senior midwives, consultants, etc to make sure I'm ok for the next birth. Which is amazing :)

midivydale, I sympathise with your post so much. I have to say at 9 months after the birth it was still fairly raw for me to. Now, 14 months on, well, if I think about it I still cry but I think about it less so I think it fades. I feel it will always be there as a terrible memory. I mostly feel sad about it all. The day my son was born should have been the happiest day of my life but I feel a bit robbed of that due to the experience I had. I'm glad you had counselling. One thing that really struck accord with me was my women's health physio, when telling me I should see a counsellor, saying that it would be terrible if my decision to have another baby or not was based on fear rather than what was right for our family. Anyway, I hope you can reach a stage where you can make that decision from the right place.

I had a birth experience that really did traumatise me but through all the subsequent meetings with the counsellor, senior midwives, consultant, etc I have been reassured that I can have a c-section next time if I wish or if I am nervous about the birth. The problem is this is the last thing I want!!! I hated the lack of control last time and I feel a c-section would be worse. I hate anything 'medical', which is why I wanted to give birth in a birth centre. Despite things not going to plan in the birth centre things didn't get really bad until I was transferred to the labour ward and the thought of going through that again terrifies me. What I want is to have the experience I tried to have last time but I've been told I won't be able to go back to the birth centre because I won't be low risk anymore. I'd like to insist on a home birth but I'm not sure that is realistic or possible so I don't know what I'll do. But any mention of my fears and I just feel like I'm trying to be persuaded a c-section would be best. I'd like another baby in the not too distance future but the giving birth issue is still tricky for me. I think it is great if women do need a c-section due to fear of giving birth are offered them but it's not the only answer :-(

[Otta]

When my wife had our first daughter at Thommy's, most of the labour was during a bank holiday Monday (having arrived Sunday night for an induction). As a result, the midwives on duty, whilst absolutely lovely to a woman, were overrun, and having to spread their time between several people each (more than even usual).

As a result we were left alone with very little information at a time when you want someone "in the know" to be there talking you through it and reassuring you. Throughout she was told there was no chance of a c-section, and they tried and tried to deny her an epidural for hours of her in terrible pain (and she is no wuss). Finally she was given an epidural around 6pm Monday. Fast forward to about 6:30am Tuesday, and suddenly the midwife pressed an alarm and loads of people rushed her in to theatre without a word of explanation. I genuinely thought maybe mum and/or baby were in real danger (I know that sound dramatic, but how the Hell was I supposed to know what was happeneing).

Anyway, our daughter was born via Ventouse & Forceps (*shudder*), and my wife and baby ended up staying in hospital another 8 or 9 days haing blood transfusions and all that jazz, which must have ended up costing the trust a lot more than a c-section would have.

Don't get me wrong, my wife WANTED a natural birth, but there comes a time when surely they should be quicker to make decisions, and there should definitely be more support.

A couple of months after all this, my wife still wasn't clear why everything had happened the way it had, so we went for an appointment with either the head, or one of the head Obstetricians. A really unsympathetic, and frankly unpleasant lady who sent my wife away none the wiser, and feeling like she was a total wuss for saying it was difficult! (BITCH!)

Not for a second saying this was the worst experience ever, I'm sure there are many similar or worse birth stories, but it was still pretty scary for us.

Second daughter born by c-section at Kings, but only because of a late diognosis of diabetes 2 days before the due date. Much better experience all round except my wife hated being away from our first daughter whilst she was recovering in hospital with the baby.

Aaaaanyway, blah, blah, blah. The point of all that was basically that it would have made a huge difference to have someone in our corner the whole time. 99.5% off staff in both hospitals during both births were wonderful, but there just aren't enough of them to deal with the demand.

[TE44]

I think for medical staff to recognise the fear of giving birth it would come down to rational or irrational fear, I personaly feel it is a natural to have fears especially with your first. I think when faced with medical fears, it is hard to keep them separate. Of course a medical person can rationally have concerns, and will not only recognise a problem but do what they can to avoid a situation that may occur. Because you know the advice given comes from people who have more experience and know so much more on the physiology side, it is difficult to keep hold of your own feelings, especially in labour. Where there are health problems, I found they were not happy to give any control to me, regardless of the fact I had understanding of my problems. Of course I also understand the situation they are in, and they are advising on what they believe is best, often, unfortunately though, there isn't room for what the mother feels.

[Otta]

To be honest, I'd be a bit worried about any woman who didn't have at least some fears about giving birth!

I'm a bloke, and I wake up in cold sweats before a dental appointment!

[pripolla]

I wonder if the trauma will ever be over... My daughter is 5.7 yo, so it's nearly 6 years, and I still can't even think about the awful experience of giving birth...

High risk pregnancy due to high blood pressure, 36 hours in pain before the epidural, emergency CS, followed by another surgery 24h later due to medical negligence (the stittches were not done properly), resulting in a pulmonary embolism and 10 days in ICU ( St Thomas').

[snowboarder]

Having had 2 c sections (1 'emergency' and one 'elective' - but neither were either, iykwim) - I would only caution that they are not necessarily the answer to a relaxed calm birth. I found them both traumatic in different ways, and both resulted in a stressful week in hospital post birth...

Sorry - don't mean to scare, but just wanted to alert...Obviously well planned elective cs can be good experiences. There is a really nice u tube clip somewhere that shows a 'natural' cs - think might have seen it on here? Can look it up if anyone wants.

[snowboarder]

Oh - here -

http://www.youtube.com/watch?v=m5RIcaK98Yg

Sorry - have wandered off topic a bit maybe....

[Cyberia]

Thanks for sharing, all - and reading through the above, in some ways I wish my fear of childbirth could be solved by a planned c-section... unfortunately, a c-section is the very thing I fear! It may be irrational, but there you are, on this point I guess I just am.

So far I've been lucky enough not to need one, but given the stats for London hospitals it's a possibility that looms very large when I think of possibly having another baby. Wouldn't want to push my luck. No guarantee can be made that it won't happen. And it's all very well discussing these things in the NCT/NHS ante-natal classes (most of the parts on birth in both of these, for me anyway, were focussed on 'complications'!) but that didn't help me at all.

Not sure counselling would help either, given the fundamental problem can't be solved...

[Saila]

which takes us back to Saffron's first point (which i totally agree with).

Should the NHS approach to birth be this "one-size fits all" strategy? when the knock-on effects are costly both emotionally and financially for the mothers and the nhs.

Quote saffron:

It seems to me that there is a (false) sense of saving money or services by trying to shoehorn women into a one-size-fits all experience for labour and birth. In contrast, I think the stress caused by not providing adequate support, especially to first time mothers, could well result in poor birth outcomes leading to less cost-effective outcomes overall. Surely giving women more control, in the form of more choice, would not be more expensive than treating women for poor birthing outcomes resulting from distress in labour and birth.

[Jo'sEnglish]

Yes Saila, I totally agree with that point of Saffron's too.

I think that is the problem I have, ie. Oh, she had a traumatic birth so we'll just say she can have a c-section next time so she won't be scared of birth.

The same as after my birth I felt it was very much, oh you had forceps an a nasty tear? That's why you are upset.(whereas, no, as bad as that was it was the traumatic experience I had around this with the doctor that I was traumatised by).

Too often I felt like it was assumed you should feel/want a certain thing without anyone actually bothering to listen to you.

Otta, totally agree about not being enough staff too. One of the reason I was told I didn't get the care I should have got was that it was a Sunday. For god's sake, I'm sure just as many babies are born on a Sunday so surely there should be the same amount of staff!?

[Saffron]

Snowboarder, not off topic at all, I think the topic is pretty wide. I don't even have tokophobia, but I think the topic of peripartum care for women is important for many reasons. It's a missed opportunity if the NHS doesn't make some serious changes under its new mandate.

Here's another interesting (well, I think so anyway) article about the different approaches to labour and birth in different communities. In particular this article looks at the low rate of c-section in the Amish community compared to the US population as a whole. Because, as others mention, c-sec is indeed not the only answer, and there are valid reasons why obs in general are trying to reduce the rate of c-secs. http://www.myhealthnewsdaily.com/3259-amish-birthing-reduce-c-section.html

[Saffron]

Links to the NHS mandate info in this thread: http://www.eastdulwichforum.co.uk/forum/read.php?29,998324,998324#msg-998324 (...against the backdrop of Lewisham Hospital Mat services being under threat? Maddness!)

[canela]

I was scared the first time round which made me put all my decisions in the hands of the hospital staff.....ended up with forceps. it wasn't in the uk and i think people here would be shocked.....no private rooms for most of the birth - just a line of beds separated by curtains.

whilst i wasn't deeply traumatised the experience made me fight my corner and get a home birth the next time round. it wasn't available on the nhs and i had to pay a LOT of money for it, but i just really wanted to have a good birth experience and knew i couldn't do this in a hospital. no fault of the staff necessarily - just a result of the way it is all set up. i was more scared of the hospital than of the birth. it was so worth it. i think it's so sad how difficult it is for women to get a birth experience that is right for them. the effects of a traumatic birth can be deep and scaring - surely worth making the effort to give women that bit more support.

[midivydale]

Thank you all.

Saffron- as always so informative- thank you.

Yes I am still receiving councelling and I was referred for PND.

My main issues are anxiety related rather than feelings of sadness but the diagnosis was PND all the same. I remember it so clearly as I was so scared after the birth- i have never felt panic like it and that is how it started (my anxiety issues).

I was referred very very soon after the birth in March (too soon in my opinion to have reached the conclusion that it was PND). A midwife at Kings sent the ball rolling I believe. Still, I wasnt seen until June and I am still

getting treatment. I am miles better - truly- but the birth is yet to be discussed, strangely enough.

Sorry this is off topic, just wanted to respond to saffron

[mrs f]

I think snowboarder has a point here, perhaps CS aren't always the instant answer, I was lucky enough to have community midwives with my 1st & I'm with them for my 2nd and I can't actually imagine not having that consistency of care. The impact on having one midwife or one small team of midwives through a pregnancy & birth experience is huge and not to be underestimated.

Not that I'm saying we can all have wonderful natural births with community midwives but that perhaps if we have more consistent care it can help everyone. It's more likely people's fears will be addressed before we get to the labour stage and its very reassuring having someone you know with you during labour, surely that consistency of care will help any postpartum issues too?

Random point perhaps but perhaps it's not just the csection policy that needs to be addressed to give women better birthing experiences?