tokophobia

After writing my first blog yesterday (found here), I started thinking about fear in childbirth; not too long ago I was educated about an anxiety disorder called tokophobia.

Tokophobia is a a fear of childbirth (from the Greek tokos, meaning childbirth and phobos meaning fear). This fear stems so deeply that women who suffer this traumatic disorder usually don't bare children, though many of them desire babies of their own. If they do become pregnant, they typically request cesarean sections.

Dame Helen Miran spoke of her fear of childbirth in a British magazine in October of 2007. As a young girl - 13 years of age - in Catholic school she was shone a traumatizing video of a birthing mother (sound familiar?). This video jaded her perception of childbirth. As such, she never became a mother.

You can read the rest of her story here.

There are many variables which can cause this anxiety disorder. If a mother has a traumatic birth experience and shares that experience to the fullest detail with her daughter (i.e., "labor is the worst pain I've experienced in my life!", "I had a 4th degree tear that ripped through to my anus!"), her daughter could possibly garner a fear of childbirth. Women who've experienced sexual abuse as a child may have fear of vaginal exams. If a woman has had a family member die in labor, that could cause her fear; as well as previous traumatic birth experiences by the mother herself.

Below are some articles that discuss tokophobia to great lengths. The first article I found the most interesting. It consists of a study that took place in United Kingdom at Queen Elizabeth Psychiatric Hospital in Birmingham. Twenty six women were included in the study, the findings are very interesting.

Of the 26 patients, 8 of the patients had primary tokophobia, that is their fear of childbirth predated their pregnancies. Of these 8 women 4 achieved their perfect birth, and had no problem bonding with their children. The remaining women had vaginal births (most against their will), where two suffered PTSD.

The remaining 14 women in the study had secondary tokophobia, their fear developed after the trauma suffered from their first births. One woman of the 14 had an abortion (rather then face another delivery) when she became pregnant with her second child. Several had miscarriages, and one had an ectopic pregnancy. These women were pleased that their pregnancies had to be terminated.

You can find the rest of the study here.

Here is another article: Tokophobia: Fear of Pregnancy and Childbirth

Do I think I suffered from tokophobia. Perhaps. The thought of labor frightened me so much that I longed for a c-section. However I was never so afraid that I wanted to terminate the pregnancy.

Unfortunately tokophobia isn't a widely known disorder. Fear and anxiety are common emotions for first time mothers, and I have a feeling that those who express these concerns are told that what they are feeling is normal.

I also believe that the enormity of the disorder is not well known. I would imagine feeling complete dread over childbirth can cause embarrassment. As such, I'm sure some women keep their feelings to themselves, never telling a soul of the anxiety that they feel whenever they see pictures of birthing mothers, or hearing birth stories.

This is why I try not to pass judgment of others birth choices. You never know their back story. Perhaps the woman that you were speaking to today about her scheduled cesarean is tokophobic. Would you begrudge her her ideal birth just because you do not agree with her choice?

her-story (part 3)

My Journey to VBAC

When I found out I was pregnant with baby #2 I hadn't even considered VBAC. I was under the impression that "once a c-section always a c-section" applied. Luckily I belonged to a message board where, only months earlier, a poster went on her own VBAC journey. Her story inspired me. She wasn't afraid of labor, she embraced it. She was strong. She was empowered, and I wanted to experience that too.

I still toyed with the idea of a repeat c-section. There were a couple of minor benefits: 1) I knew what to expect, and 2) I could schedule the delivery, making it easier to arrange childcare. However, I knew that if I were to have a 2nd c-section that would be it. I would always have my children delivered for me. Was that something I really wanted? Would I regret not even trying to birth?

I started to do some research. I wanted to see what child birth could be like. I looked up birthing videos on youtube. I started to read birth stories. Yes there is pain involved with labor, but once a mother pushes her baby out the pain disappears and a feeling of euphoria emerges. I wanted to experience that. I never had that euphoric feeling with Manny. Did I love my son? Of course. Was I happy to become a mother? Of course, but seeing how happy these women were made me jealous. I wanted to experience what they had experienced. In my 4th month I finally decided that I would birth my baby the way nature had intended.

The last 5 months of my pregnancy consisted of becoming as well versed in the subject of VBAC as humanly possible. I studied rupture rates (less then 1%). I learned what to avoid in order to make my birth a success (prostaglandin induction, artificial rupture of membranes (AROM), pitocin, epidural, purple/directed pushing in the lithotomy position). Unfortunately I couldn't afford any childbirth prep courses, so I bought as many books, on as many subjects as I could. I felt that I was prepared for any and everything.

I had learned that having a doula would increase my chances of success, but unfortunately that wasn't something we could afford either, so I tried to have John read as much as possible. We would do fine...or so I thought.

Unfortunately I was racing the clock. My doctor didn't feel comfortable with me going past 40 weeks. I told her that I wasn't comfortable scheduling my c-section before 42 weeks. We made a compromise, and I would be having a repeat c-section if I didn't go into labor, on my own, before 41 weeks 1 day.

At 40 weeks 2 days I went into early labor. Contractions started that evening. It was Friday night and I was contracting every 10-15 minutes. The contractions continued through the night. They were uncomfortable, but not unmanageable. I slept (restlessly) about 4 hours that evening. By Saturday morning I was contracting every 5 minutes. Again the contractions were uncomfortable, but not unbearable. We called my dad that morning around 8:00 a.m. and told him that he would need to make his way over to our house.

John and I left for the hospital at 12:00 p.m. I was admitted to triage where they hooked me up to a bunch of monitors, and checked my dilation...I was ONLY 2 friggin' centimeters! My worst fear had been realized. I had been up ALL night with contractions, and they weren't doing a damned thing!

Here is where the cards started stacking against me: because I was a VBAC patient I was admitted into the hospital. If I were a regular laboring mother, I most definitely would have been sent home. I was immediately wheeled into a birthing suite, where again, I was monitored for 20 minutes.

Over the course of the following (several) hours I walked, I showered, I bounced on a ball. Contractions were about 3-5 minutes apart, and becoming increasingly painful, so much so that I had to stop everything I was doing to make it through them. John helped me as best he could, but he could definitely see that I was starting to crumble. If I stayed on top of the contractions I was able to handle them, but the moment that I "let loose" I fell apart.

After what seemed like an eternity the nurse came and checked me again. I was still only 2 centimeters! I just about died. I was losing my resolve. I let the fear seep in. If these contractions were this painful, how in the HELL could I handle active labor, or even transition!?! I lasted another hour before I begged for the epidural.

I knew what would happen after I got the epidural. I had read about it in EVERY book that I bought. I was warned about the procedures that would follow, and was told to avoid them at all costs. Unfortunately that epidural sealed my fate.

Two hours after getting the epidural my bag of waters was artificially ruptured. Several hours after that I was given a low dose of pitocin. I told the nurse that I didn't want the pitocin, but she told me that my contractions weren't strong enough, or consistent. I was assured that they'd keep a close eye on the strength and length of the contractions, and if they thought for even a half of a second that something was wrong, they would shut it off. I conceded and the pitocin drip started. Every couple of hours the nurse would come in, and turn the pit drip up. This continued until they were sure that I was in transition. The last number I remember on the pit machine was 12.

I spent the rest of the day in and out of sleep. I was starving, but was refused food. John went down to get some lunch. I had him sneak me some snacks.

Oddly enough I could feel myself hit transition. One moment I was feeling fine. The next I could feel intense pressure in my abdomen, as well as some cramping. Shortly after, I barfed up the croissants that John had brought me.

I was complete at 11:00 p.m. on Saturday, March 22nd. I realized how close I was to midnight and asked if we could wait. My Grandma's birthday is March 23rd, and I thought it would be awesome to have Christian born on her birthday. I was told that I was at -1 station, so we needed to wait a bit anyway. The nurse tilted my bed to a 40 degree angle so that gravity could take over.

I started pushing at 12:15 a.m. I couldn't feel any contractions, so I had to have directed pushing in the dreaded lithotomy position (flat on my back). On counts of ten I held my breath and "bared" down.

Christian was born at 12:45 a.m. March 23rd (Easter Sunday) and I had given birth to him vaginally. I suffered a 2nd degree tear to my perineum, as well as several small tears to my labia.

For several days (possibly weeks) following Christian's birth I was on a high. I was so proud of myself for birthing my baby. It wasn't until I had a moment to catch my breath that I realized Christian's birth didn't go at all how I had planned.

I know exactly where I went wrong: 1) I went into the hospital too early, 2) I got an epidural too early. Had I waited on both of the aforementioned, I know that I wouldn't have had all of the interventions that I did have.

I know exactly what I would do were I in that situation today:

• hired a doula, this is a biggie. I know hiring a doula would have changed the entire tone of my labor. I think I expected too much from John. I think we, as woman, have a tendency to do that to our husbands/significant others. Childbirth isn't their "realm", and it was unfair for me to put that kind of pressure on his shoulders.
• stayed at home longer.
• not gotten an epidural, or wait at least until I was in active labor to get one. I would also request to have the epidural turned off during the pushing phase.

I have come a long way since my first birth. I now know what child birth can be like. I have not experienced my "perfect" birth, and who knows if I ever will, but I know this: Our bodies were designed to create life. We were designed to birth the life that we created. Yes, child birth can be painful, but it is not something to be feared, it is to be celebrated.

her-story (part 2)

Ignorance is Bliss

At the age of 23 I found myself in a loving, stable relationship of 4 years. I also found myself unexpectedly pregnant. Oddly enough, the moment I found out I was pregnant (at such a young age) I wasn't scared of my emotional well-being (that came later) I was scared of birthing my baby.

The 9 months following my positive home pregnancy test were fairly easy. I had horrible morning sickness for the first four months (I figured this was my penance for being irresponsible and getting pregnant so young). I was scared to become a mommy at such a young age, but I knew that with the help of my awesome (now) husband, everything would work itself out. But mostly, I was terrified of giving birth.

When a woman finds herself pregnant birth stories come out of the wood work. Horror stories. People feel inclined to tell you how painful child birth is, how much you'll NEED the epidural. They tell you painful stories about episiotomies, and 4th degree tears. Nobody ever tells you that it can be beautiful (I take that back, my mom told it could be beautiful, but I think I tuned her out...haha).

As each month of my pregnancy passed, I prayed that I would need a c-section. For me, it seemed like the ideal option: 1) I wouldn't need to experience labor 2) I wouldn't need to push a baby out of my hoo-ha, and 3) I could schedule when my baby was to be born...PERFECT! Unfortunately, that opportunity never presented itself....until my 38th week well check.

At 38 weeks I found out that my little bun had flipped to breach. I tried not to smile as my doctor told me, but I could feel myself get lighter. I could breath. I could sit up straight. There was nothing to fear. It was as if someone had answered my prayers. I would be getting my c-section!

On the morning of March 2nd my husband drove me to Mills-Peninsula Hospital at 5:30 a.m. I was prepped and walked myself into the O.R. at 7:30 a.m. Up until that point I wasn't aware of the gravity of the situation.

I was having surgery today.

I know it's ignorant, but the fact that they would be cutting me open never really bothered me until I was sitting on the operating table. I looked around the room to find a comforting face. The only thing I saw were nurses buzzing around the room preparing for my operation; they're faces covered with masks.

I sat on the cold steel operating table, my gown opened in the back (I was freezing). The anesthesiologist approached me and told me that he would be inserting my epidural. I felt him clean my back, and stick me with a small needle. He told me to expect a lot of pressure as he inserted the catheter.

The epidural took effect almost instantly. I was laid down before my legs went completely numb. As I was laying on the cold table, the weight of my belly made it difficult to breath. My breathing became more labored as the epidural started to work. I felt suffocated, which caused me to hyperventilate. I remember telling the nurse, "I can't breathe!" They tried to comfort me and tell me this was normal. I was told to take long deep breaths. Moments later I started to throw up. Internally I was screaming for my husband. The nurse even asked if she could let him in, but the anesthesiologist didn't think it would be wise to bring him in when I was so distraught.

The rest of the morning is a drug induced blur. Here is what I remember:

• John eventually being let into the O.R.
  
• Being grossed out at the blood spatter on the drape in front of me.
  
• Tugging and pulling.
  
• Manny being pulled out of my belly.
  
• Being wheeled into the recovery room.
  
• Waiting (for what seemed like hours) for the anesthesia to wear off.
• Trying to nurse Manny.
  

My recovery was fairly easy. I stayed in the hospital for four days following my surgery. Manny was born at 7:59 a.m., and by 5:00 p.m. the nurses had me walking around my postpartum room.

When I was discharged I never had my vicodin prescription filled - I didn't need to. I was walking and climbing stairs on day 2 of being discharged. My incision did open slightly, but after seeing a doctor I was told that it had healed enough to where it wasn't a problem.

After some reflection I've decided that my cesarean experience wasn't completely awful. Yes, I was terrified in the O.R. and had a minor anxiety attack. Yes, it is difficult to recall some details of that day because of all of the medication that was flooding my system. But, it could have been a lot worse.

her-story (part 1)

(I had originally made one loooooooooong story, but I decided to break it up to make it easier to read)

When I was a Sophomore in high school I attended my 4th period Human Development class on a sunny Spring day. This week we were discussing human sexuality. On that particular day we would be discussing child birth. If I'm completely honest I don't remember the lecture at all, what I do remember was the video that was shone.

It was a video of a laboring mother. She was screaming, grunting and breathing rhythmically. She was in transition on the verge of pushing. It was the scariest thing I'd ever seen in my short 15 years on this earth. Moments later the camera moved in between her legs where you could see a bulging perineum. The lips of the womans vagina stretched as a small head made it's way through the opening.

My eyes wide, my chin hitting the top of my desk. I watched in horror as a small human emerged from between her knees. I remember the statement I made at that point, " I will NEVER be doing that!" That evening I told my parents that I would never be birthing my own children. If I felt I wanted to be a mother, I would most certainly adopt.