Any proof that birth phobia is a medical reason for C-section?

[tangtang]

I have birth phobia, I went to see my NHS psychologist a few days ago. When I asked if I can get a C-section because I have birth phobia, she said phobia is only a mental problem, not a medical reason. She also said only physical problems are medical reasons for C-section, and consultants will ask her for opinions before deciding whether to give me C-section because of phobia.

I see from many posts that birth phobia is a medical reason, and my GP also said I can get a C-section because I have birth phobia. Where can I find the official definition that birth phobia is a medical reason for C-section? I don't understand my mental illness is not a medical reason. How do I argue with my psychologist?

Is this your first? My understanding is that you may be considered for csection if you have birth phobia from a traumatic birth experience in the past but rarely with first babies. The problem is many women are terrified of giving birth but they can't offer everyone sections.

In regards to proof I would doubt there is a definition that would directly help your case as again, if there was more people would choose them, however, it may be a better idea to provide proof to the Nhs psychologist of how serious your phobia is. You could discuss further with your GP if he thinks a section is possible ask him how- he may be able to make suggestions- perhaps counselling which would provide more 'evidence' of your phobia but at the same time may help you overcome or prepare you incase you are turned down.

Sorry it may not be all you want to hear but good luck I hope it all works out

thank you rosduk:) i will talk to my gp.I have serious panic attack when i hear something about pregnancy and childbirth. I fainted many times in hospital. My psychologist know how serious the phobia is. I think even i agree with normal delivery, i still will faint when i am going to delivery in hospital.

But how is the major operation involved in a Caesarean Section going to help? You say birth phobia, but C/S is still birth, you might still faint etc. Is it the fear of pain? What is the root of the phobia. This is what you need to address before blankly saying I want a Caesarean.

Usual caveat, This Is Just My Opinion.

I had a CS for my 1st DC on the NHS because of birth phobia (primary tokophobia). On the recommendation of my perinatal mental health team.

I've got to run off now but will come back to this thread.

The Detective, you clearly don't understand the nature of this phobia at all. CS is a very different kind of birth - I had a great CS, I could not contemplate a VB.

Many women with this phobia are sexual abuse survivors or have endured sexual assault and rape. It's a very difficult area, and if you don't understand, the least you can do is try not to judge harshly. Easy to say 'address the root of the problem' - if you are already pregnant, or your biological clock is ticking, you may not have time to go through effective counselling or phobia therapy. It can take years to untangle a traumatic history, believe me.

I'll come back OP.

I do not have a phobia of childbirth but had a ELCS for my first child on the NHS as I did not want a vaginal birth or the associated risk of damage it can cause (yes I know CS can cause damage but I was prepared to accept that). The only person who can agree your CS is a consultant and you need to get an appointment to talk to one ASAP as it's not a quick process and remember you are entitled to a second opinion so dont be afraid to use it (I had to).

I'm back.

Tangtang, it's not clear what your psychologist is saying.

IF she is saying that consultants schedule CS births for purely physical reasons, and not for mental health reasons, then that's (mostly) true. However, C sections can be carried out for mental health reasons - such as trauma from a previous birth, as as in my case, severe primary tokophobia. Some women have had a CS agreed just by the consultant after meeting them and discussing things - others, like me, are sent via the perinatal mental health team, who then liaise with the consultant. It seems to vary hugely across the NHS.

My psychiatrist recommended me for a C section. I had a wonderful birth, and from the point the CS was agreed, an anxiety-free pregnancy.

It may be that your psychologist is saying she needs to recommend you for a CS for the consultant to agree to it. She may be letting you know what her professional role is - in general, with any mental health issue, you have to 'be diagnosed', rather than diagnose yourself. You can go to the doctor, tell them you think you are depressed and they can make a diagnosis from your symptoms - but they take a dim view if you go in, tell them you're depressed and demand anti-depressants, for example.

However, it sounds as if you think she means that a birth phobia isn't a reason for a CS, and she can't recommend you for one? Or a consultant won't agree to it? In which case, she's just wrong.

If it's the latter case, I don't think 'arguing' with her will help you much, tbh. I'd say you're better off going back to your GP, or asking to speak to the consultant MW at the hospital, and asking them to send you to another psychologist.

The guidlines for asking for a CS due to fear of birth are here - page 12 - www.nice.org.uk/nicemedia/pdf/CG013NICEguideline.pdf

All they have to say is: - "When a woman requests a CS because she has a fear of childbirth, she should be offered counselling (such as cognitive behavioural therapy) to help her to address her fears in a supportive manner, because this results in reduced fear of pain in labour and shorter labour."

However, this means 'offer counselling FIRST'. It doesn't mean 'offer counselling only'. If counselling is deemed unlikely to work, then a CS can be offered instead. [I also have other issues with this - fear of childbirth is not 'just' fear of pain in labour, that's one of the most basic misunderstandings about it. And one of the things that can make other women behave appallingly towards birth phobia sufferers. Don't get me started...]

I'm generally pro-counselling - I've had plenty of it, and most of the time, it's been beneficial. But it's not necessarily a quick fix, and if you are pregnant, going back over traumatic territory while the clock is counting you down to birth can create even greater anxiety, and be counter productive.

It might be an idea to approach it with an open mind - it might help you get a CS if they can see you've tried it. EVen if you turn up and can't bear to talk about it, hear about it, see images etc, then that says something about the strength of your phobia.

I posted on this thread when I was pregnant, as barkfox - there may be something helpful there for you. www.mumsnet.com/Talk/childbirth/954334-Anyone-asked-for-ELCS-for-first-baby

Is it just a birth phobia or a hospital phobia too - you mention fainting in hospital? A CS means more hospital time - plus ELCS's are almost always done under spinal anaesthetic so you'd need to be able to stay calm throughout an operation as well as a hospital stay. I really doubt many consultants would okay CS under GA for psych reasons as the risks to both of you are so much higher.

well I was going to post something about hypnobirthing but after reading Gloyw's post I can see it might be utterly irrelevant - but if the consultant insists on you having some form of counselling to attempt to reduce the birth fear/phobia, then I would recommend hypnobirthing as an option. It works very well on lesser "birth fear" - so while I am not saying that it would work on birth phobia, it might reduce it - but I don't know. Just offering it as a more specific alternative to CBT.

Good luck and I hope you get the outcome you want.

I would suggest you get more treatment before opting for a major operation. I had to have an emergency section for my first baby and that has resulted in us having a smaller family than we wanted.

thumbwitch, that's not an unreasonable suggestion - I think personally in general, hypnosis can be a good way of managing 'normal' anxiety - although the problem with phobias is that they are by definition outside the range of 'normal', and given there are often very complex and longstanding issues underlying a birth phobia, hypnosis to manage anxiety without addressing these issues might aggravate the problem.

A key issue is whether someone is able to try and tackle their phobia before getting pregnant. Which is the sensible thing to do, of course, but it takes a huge amount of courage to go and see a doctor about something which terrifies you, and to open up territory which, if you aren't actually pregnant, it's easier to avoid. We don't know if the OP is pregnant or not. Being pregnant means you enter any counselling with the pressure of a ticking clock, and that's far from ideal. I've seen similar threads where the response 'go get counselling, don't have a CS' is offered as standard. That's not always an option, nor does it have guaranteed success (and as I say, I'm generally pro-counselling).

Other posters - yes, of course CS is a major operation. However, an elective CS under spinal is a very different procedure than an ELCS, and the OP hasn't suggested at all that she wants a CS under GA.

With all due respect, what you aren't taking into account is the PSYCHOLOGICAL benefit of having a CS where this is a strong birth phobia. The risk of forcing tokophobic women into having VBs against their will is to their mental health - flashbacks, PTSD, PND, bonding problems with their babies - these are all things to take into account ALONGSIDE the physical risks.

Women do not opt for a major operation with attendant risks unless, in the balance of pros and cons, it is a better option for them personally. Please try to bear that in mind. There is so little understanding about this phobia, and a huge stigma attached to talking about it.

happy to see so many post when i wake up today. Thank you all for these help.
I am not good at english ,i feel really stressful to discuss with doctor about this phobia again and again, especially when i think she refuse me or cant really understand me.I am pregnant 11 weeks now,before pregnant ,i already have treatment for this phobia in my country for six month. things get some improve, before the treatment, i even cant discuss like this on internet,cant see anything about pregnant childbirth even hospital. now i feel better to talk about some simple things. but everytime when i go to see GP,I still shake and hard to breath.In that condition ,its really difficult to communicate with doctor.

anyway thank you again. so many useful information help to understand how NHS works.

I will let my husband read this and ask him to speak to doctor instead of me.

That's a very good idea, tangtang - if English is not your first language, it must be very stressful to have to deal with thinking in English AND dealing with your feelings as well, so if your husband will advocate for you, that would be very helpful indeed.

It might help as well to, with his help, write down how you feel about things in simple statements. (I'm assuming he is English, is he?) Then whenever you need to see a new medic of whatever level, you can start off by giving them your statements to read, so they start with a basic grasp of the problem.

Chynah - how did you wrangle your c -section with those reasons?

I'm not judging you at all but I'm having major probs getting a c -section for DC2 after experiencing birth trauma with DC1. The doctors are making my life really diffucllt and causing me a load of stress. Advice please!! What is your secret?!

thank you thumbwitch, its a good idea to write a simple statements,i will do it. my husband is not english either,but he is much better than me,specially,he can understand what i want to express. i let him write my statement, and show it to my new doctor every time. unfortunately,he cant go with me every time because he need to work.

This is probably not helpful since I imagine you have already gathered more info than it supplies, but there was a sympathetic article in The Guardian a few months ago -- and at the bottom of the article there is a link to the Birth Trauma association, in case you haven't aleady got that.

Good luck. I have a friend who went through vaginal birth despite tokophobia, and it was a very bad experience for her. Perhaps it wouldn't be for you: perhaps you could find ways of being resiliant, but I really strongly feel that the professionals ought to make the alternative of caesarian very available to you, so that you can mkae the best choice for yourself.

Good luck.

CJ2010 - Sorry to hear you are having a hard time unfortunately I think it depends on where you are and who your consultant is with the NHS. I was refused but changed consultant who (reluctantly) agreed after my husband (he's much better at those sort of things than me) had a long conversation with the consultant over his fears for the health of his wife and unborn son etc (I just cried a lot!) . Can you not change consultant for a second opinion?

gloyw
Reading the OP's second post, it came across as more than a fear of vaginal birth, but birth itself, and hospital/pregnancy in general. I was simply saying that a caesarean section might not be the answer in this case.

Like I say, it was just my opinion on reading the second post.

I do actually have indepth knowledge on birth tokophobia. Hence why I clicked on this thread.

I apologise if I misread you, TheDetective - I've seen similar comments before about fear of pain, and 'you say birth phobia but C/S is still birth' etc - and it's not been from a point of understanding, but of dismissal.

If you have in depth knowledge of tokophobia then great, and please do share it if you are able. As a birth phobic, I've found it incredibly isolating, and genuine understanding is thin on the ground, IME.