tokophobia: fear of childbirth

[Saffron]

mrs f Wrote:

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> Random point perhaps but perhaps it's not just the

> csection policy that needs to be addressed to give

> women better birthing experiences?

Indeed, mrs f totally agree. In fact, if you read webapages on the new NHS Mandate, they talk explicitely about these issues:

What does the Mandate mean for pregnant women?

We want to improve the standards of care and experience for women and families during pregnancy and in the early years for their children.

The NHS will:

?-offer women the greatest possible choice of providers

?-ensure every woman has a named midwife who will make sure she has personalised, one to one care throughout pregnancy, childbirth and during the postnatal period, including additional support for those who have a maternal health concern

?-reduce the incidence and impact of postnatal depression through earlier diagnosis, and better intervention and support.

In addition, women who use maternity services from October 2013 will be asked whether they would recommend those services, as part of the ?"friends and family test?".

http://mandate.dh.gov.uk/pregnant

I just hope that all the good words on paper don't get lost in translation when applying the Mandate to real life. It really is about individualising care, IMHO. There are women on both sides of the hospital "issue". Ie, women who would prefer their birth experiences not to be medicalised, and women who would feel safer in a hospital. It's also about recognising that the best laid births plans may need to change dramatically at the last minute to accomodate the dynamic circumstances surrounding labour and birth.

I am in favour of improving the current system both to provide more support for women who want home births, but also to ensure that (particularly for first time mothers) women who want to labour in hospital at any stage can do so without being turned away.

@Midivydale, as you can see the Mandate includes mental health issues associated with pregnancy and birth. I can imagine for some people that postpartum depression can become part of tokophobia. But even if it doesn't, all of these perinatal issues are important for women's health (and the associated well being of their families).

I almost wish I were having another baby, just so I could test-run the changes! In any event, perhaps now is the time to address long-standing issues and ways that our birth experiences were traumatic (or, beneficial). Maybe put it all in a letter and send it to (a) the midwife / labour unit, and/or (b) the Commissioning Board? Hmm will have to give that one some thought. There is an opportunity for change here not to be missed. For some of us, it's too late, but we could be making changes that will affect our daughters (and sons).

[midivydale]

I was wondering if anyone has managed to go through the process of elcs on the grounds of tokophobia/ptsd/traumatic previous birth rather than strict medical grounds. Although it could be argued that mental health is actually medical grounds? If you have experience of this would you be happy to share it? PM if you prefer. I confided in my midwife at the booking appointment and she was hugely supportive. She has referred me to talk through my options with a consultant at Kings. Does anyone know what happens at such an appointment, and after? Is there a series of appointments you would need to go through? Any advice welcome. Many Thanks.

[Monkey]

in my view the immediate after care on the post natal ward could help start ease if only a tiny weeny little bit of the trauma. Instead it adds to it. I was treated like a naughty school girl who has had sex and now had to bear the consequences. It's tainted my view of midwives if I'm honest.

[Saffron]

Congratulations first of all, midivydale!

I've no idea what happens next, but it sounds like you've made an excellent start.

Perhaps forumite Sillywoman can shed further light? Message her on the forum? Or, if you PM me, I can put her in touch with you IRL. xx

[hellosailor]

You can choose to have an elcs for those reasons now xx

[sillywoman]

Well, my understanding is that each NHS Trust has a slightly different process (different hoops they want you to jump through), but on the whole the process follows roughly this path: You speak to your midwife asap about your need for elective caesarean (ELCS), they then refer you to speak with a consultant, or a member of the consultant team who will want to speak with you to ensure you understand the increased physical health risks to you, your baby and any future pregnancies associated with ELCS. You would listen to these then nod, and explain that whilst you understand what they are describing, the risk that being forced to undergo vaginal birth poses to your mental health outweighs all of those other risks for you. They then either give the okay for an ELCS there and then, or (in some Trusts) insist on you undergoing a course of counselling before they will give the go-ahead (I've only heard this on the grapevine - so it could be hear-say, and I haven't heard this in regard to any local Trusts as yet). In my experience it seems it's easier to get an ELCS if you're requesting it on grounds of a previous traumatic birth than if you are requesting it with a first pregnancy for some reason - I'm not sure why that would be though? HTH x

[midivydale]

Thank you all, very informative. Thank you. My midwife did say that the consultant might request counselling. I would be happy with that if that?s needed. You never know what can happen, there could be a potential risk of early spontaneous labour for example so if offered councelling I?m happy to take it. Whilst my main reasons for wanting an elcs is for mental health reasons those are not the only reasons. There were some pretty awful physical complications from the previous birth which I?m still not completely recovered from. I?m really scared that those problems would worsen during a second labour. This fear in turn obviously impacts my mental health. The councelling might help me deal with those fears but won?t make the physical problems go away. I have read

Up and fully understand the risks associated with an elcs. I am under no illusion that it would be a walk in the park . But a crash forceps delivery certainly isn?t either and I just can?t go through it again. I just hope I will be listened to. My midwife was lovely and supportive which was very reassuring.

Thanks for your time everyone, really appreciate it. It has taken me many years to even contemplate doing it all again. We will see how it goes.

[Jules-and-Boo]

If you had a traumatic experience, it's pretty certain that you can choose a CS for the second/ next.

The choice was offered to me for my second and I felt fully supported and properly looked after at KCH.

Counselling is great - if you think you need it - you do! Look around, find someone you work well with - move on if not.

Bear in mind though, they are supposed to get much easier after the first one - and a CS is a pretty serious operation. Maybe you find that talking it through makes it all ok.

Best wishes - do what you feel comfortable with.

[Ellie78]

Posting because of relevant recent experience - though not exactly on a par with the op.

I had a tough first labour (slow progress, 72 hours with no sleep, liberal use of induction drip, bad tearing from assisted birth) and recently my pregnancy went to 42 weeks. I was with St Ts (hoping for a Home birth) and they wanted to induce me. I had to talk to 2 consultants (Midwife and dr) and explained to both why I wanted an ELCS instead. They were both very respectful of my decision and my reasoning - obviously I had the leverage of them wanting the baby out in the first place, but I never experienced any pressure to do something I was absolutely dead against doing.

Not that this is a contest, but I know from talking to you midivydale how hard the labour was (harder that mine!). And I wouldn?t call what you have ?tokophobia? because that suggests to me something irrational or devoid of real life context - you have very sound reasons to want to avoid what happened before and any further impact on your physical health. If you are treated with anything apart from kindness and understanding id be surprised - that?s what you should expect.

I know elcs has its risks etc but I found it an absolute walk in the park compared to my previous experience. Not starting life with a newborn with severe sleep deprivation (i was hallucinating already from 3 nights of no sleep when I was packed off with my son) was a good start, let alone the rather brutal damage of an assisted birth....at 7 weeks on I am still recovering (ie I still have pins and needles around the middle, and I?m reconnecting with my core muscles!) but I feel more capable and confident in my body than I did before. Sure, it?s not the answer to everything but it certainly beats what happened before, and had limited the damage to my pelvic floor.

Good luck with it - we don?t talk enough as a society about the long term damage that women experience in childbirth and that needs to change. But I felt - from my recent experience - that the nhs is beginning to become more sensitive to these things.

[midivydale]

Thank you everyone. Ellie, that is really helpful and reassuring. And no certainly not a competition. Every single woman going through childbirth is a hero in my book. I feel guilty for having such a hang up about all of this, ultimately both baby and I were safe and well. You are right, my midwife actually said the same about my fears, she was lovely. She said that my fears are based on a previous experience so not irrational at all although I think that maybe the previous experience now has helped me develop some irrational fears if that makes sense. I have awful nightmares of the labour and vivid dreams of the baby being stuck for example and I experience frequent flash backs which I guess are PTSD symptoms still more than anything. All your comments are very reassuring. Thank you

[scareyt]

Hi Midivydale, I just wanted to recommend the lovely hypnotherapist Christine Neilands for help with resolving trauma and fears. She has helped me move on from some very old trauma as well as more recent and entirely rational medical fears and it's not exaggerating to say she has completely changed my life. Her charges are not cheap but you only need a couple of sessions and what she does is much quicker and more profound than counselling. I had similar reservations to you - the things I am scared of are real so how can I stop being scared of them - but she helped me so much.

[flocker spotter]

Saila, I too had a horrible first birth and dreaded labour a second time around, so I asked for an elective cesarean. To get this I needed to have an interview with a gynaecologist at Kings where I explained what happened first time around and how this had left me feeling about going through labour again. The elective cesarean was a breeze in comparison. The only downsides were I could not drive (used online shopping) and I could not lift my first born for approx six weeks. The upsides were I was mentally much better, up and about much sooner and recovered much quicker (I was not put back together very well after the first birth.)

I would recommend a cesarean if you are not wishing to go through the birthing process again.

[midivydale]

Just an update. I have had an amazing experience with the team at Kings. Everyone has been so kind and I have been treated with nothing but empathy. It has been decided that c-section is the most appropriate way forward on medical grounds. I am also getting support for my fears and flashbacks during the pregnancy. Amazing care and I?m so grateful.

[Saffron]

I'm so pleased for you Midivydale, getting the care you need! :) xx

[midivydale]

Just a brief update as I have had my baby now. I had a truly amazing experience at kings and couldn?t have asked for more. I had my c section agreed without any fuss early on in the pregnancy to avoid any further anxiety and everyone was supportive and in agreement with the choice. As it happens I went into labour before my scheduled date but the section went ahead and it was calm and controlled. I had skin to skin with my Abby straight away and I was able to donate the cord blood. I breastfed straight away with no problems (no tounge tie this time, hurrah!). It was a healing experience. Sure, recovery was pretty painful but nothing and I mean nothing compared to the pain and trauma I suffered with my first. I was lucky but I went into the choice of a c section with my eyes open and for me, it was the best option.