Need advice on working out best birth for me - tokophobia/OCD

[thunksheadontable]

I have tried to write this three times today, and every time have lost my post when I hit the button. I will copy and paste this, I have finally learned!

Anyway, long story short, 32 weeks pregnant with dc 2 and despite highlighting that I had undiagnosed OCD, PND and suffered a "dissociative" state for 48-72 hours after birth from 6 weeks of pregnancy, it took until 28 weeks before I got an appointment with the consultant psychiatrist, and even then, it was only because I broke down at the doctor's surgery.

The upshot of this is that the psychiatrist has advised it has "gone very far" and that at this stage, I need to be medicated when CBT might have helped earlier on. At this stage, and with the severity of my current symptoms, he has also said that it may be that it will be hard to get the dosage right in time for birth and that it may well be that I suffer more severe symptoms this time .

I am working so hard to try to find a way out of this, but I just feel that everyone sells me a different story on how to plan for this.

• community midwives = homebirth/hypnobirthing
• specialist "support" midwife = elective cs or induction at term
• supervisor of midwives/obstetric consultant = tried to frighten the crap out of me by giving me a range of horror stories about elective cs and to persuade me that what I need is a waterbirth with gas and air despite the fact that, of course, they can't guarantee me a pool or adequate care in birth etc; both of them really pushing that I "won't even need an epidural on a second as it'll be so fast" and that I should stay at home until there are 3 mins between contractions of at least one minute .
• psychiatrist has invited me to look around mother and baby unit to come into after birth in hospital if I do lose it. Great.

I haven't a clue what to do. I don't have time to unravel all the psychological reasons I am as I am in the next few weeks and the anxieties are coming thick and fast. I feel overwraught, overwhelmed and it is not good for my family.

Any thoughts gratefully received. I really need help and guidance from MN!

Don't want to read and run. Have you 'tried on' each option? e.g. tell yourself you are going to have an elcs and think about how that makes you feel about everything. If you have time try on each birth choice for several days and make a few notes. Then you'll have something on paper to look at with mw's psychiatrist etc.

Hello thunks

sounds like a really tricky situation but kudos to you for seeking help.

How about getting some support from a doula to help you work out what's best for you? Only you can work out what will give you what you need from the birth and it sounds like you could do with someone non-judgemental, experienced and with no agenda who is there solely to support you. If you work with a doula they will no only help you with this decision antenatally but be there for you during the birth and postnatally.

You can look on doula.org.uk for local doulas and there is an access fund if money is an issue.

I know it is hard for you, thunk but can you say exactly what it is that is making you feel so anxious? Is it the birth? Is it the fear of the last birth repeating itself?

I'm so sorry it has taken them so long to even try to help you! That is so terrible! :(

I second the suggestion of a doula. I know you said you don't have time to unravel everything right now, but are there key elements you can pin point that could at least improve your situation? For example, if there is previous trauma, or something you know would be triggering for you (certain word or phrases, or procedures for example) you can at least ensure, ahead of time that these things won't happen....

If you feel that waterbirth would be helpful for you but there is a chance you won't get it at hospital, that might be another reason to consider staying at home? This way you can jolly well get in the pool if you like, whenever you like for as long as you like.... Plus, you can do pretty much whatever else you want as and when you want it; whatever you feel will help you cope. (Because it is your house.)

Don't let any scaremongering put you off a c-section if you feel in your heart that that is what you need. Sometimes CS's really ARE necessary! and a woman's mental health is as important as her physical health! Even in the case of an elcs, a doula could be a good idea, to help you work out what your options are and help you achieve the kind of birth you want. If you decide on surgery you can still have some control and participation in the process.

Good luck, I hope you find a solution that you are happy with!

Thanks for the messages.

To be honest, I'm not really sure that it relates to anything. To try to explain it as simply as I can, basically I had a really seriously abusive childhood with a father who was a counsellor and an alcoholic and used to have terrible remorse about his actions when sober, and I would be expected to tell him in great detail how awful he had made me feel etc but only if I would immediately tell him that I also forgave him and understood he acted as he did because of his own suffering. The I would be "love bombed" for being so "forgiving" and such a good girl etc, though in reality I was afraid and playing a role.

My mother also suffered mental health issues, and the key thing in our house was that no matter how severely inappropriately someone behaved, you had to deal with it in the way most people deal with everyday arguments e.g. my mother vanished one night when I was 11 after we had a fight about homework and didn't come back til the next day, then breezed in and said sorry after I had been up all night clutching a knife under my pillow terrified and crying and explained it was because she really needed a break from me, at which point I made her a cup of tea and apologised for being so trying. You get the picture. It was just deeply fucked up.

Over the years, I've done a fair bit of work on it in therapy etc and I have carved out a happy and very functional life in general. I have a wonderful supportive husband who is my soulmate, a beautiful son, a decent career and a handful of good friends, but in pregnancy, it all comes undone.

The OCD seems to relate to the fact that at some point in my youth I made a subconscious decision that the only way to be happy in life was to always mentally believe the worst was likely to avoid having to look forward to things and then have my hopes dashed and that if I could only learn to be positive and accepting of terrible things, then somehow magically they would stop happening. Out of pregnancy, I have overcome this (or thought I had?) but I really struggle with it when pregnant.

It's total nonsense and very childish, but deeply ingrained. In pregnancy, it becomes really acute because I become obsessed with the baby dying/me dying in labour/really graphic violent images of pain and suffering occurring to me or the baby or my husband (e.g. crashing on the way to the hospital etc) because I know in a much greater way than with other traumas that if anything DID happen to me or to the baby that it would NOT be okay and could not be rationalised, and that it is not something I could just "get over"... so I go into a bit of a tailspin about it, plus feel INCREDIBLY guilty that I even think these things when other women actually have these things happen and this is all in my mind. I feel really disgusted and ashamed of my thinking, and also have this terror that I am "troubling trouble before it troubles me" and that by doing so I will "cause" the death of my baby, son or husband (though I appreciate again, rationally, that this is ludicrous).

It's like a split. There is rational, together, sorted me who sees this is ridiculous waging a war with fear and anxiety and thinking "but what if? what if I'm right and this IS the only way to stop my baby from dying?".

It's not rational, it's OCD. It means nothing, it's OCD. I can see and understand this logically, I can appreciate it, I get that it is not real and that it is a product of an upbringing characterised by terror and abuse and that that terror and abuse are no longer there. But because it IS uncertain and out of control and unpredictable, it triggers all of these crazy feelings which I really find hard to manage. It's like pregnancy just lowers my defences and ability to fight against it, so everything becomes a million times worse.

This is obviously FAR too complicated to explain to most health professionals and I really don't think they "get" the depth of my torment because I look fine on the outset. I am not wearing dirty clothing with matted hair or looking wild eyed or appearing to have lost touch with reality. The supervisor of midwives actually said to me: "don't worry, you're not one of the mad ones. Believe me, I know what the mad ones look like, and you're not one of them" .

Except, of course, I sort of am.

Sorry, I don't know if that makes ANY sense. Hard to post on this.. it's trying to condense too much into one post I feel! Let's just say I don't trust my own thinking or thoughts and am terribly afraid of being out of control, because it triggers all this stuff from when I was a kid. That is probably explanation enough!

thunk it makes perfect sense and actually considering the things that have happened in the past to you, I guess its really not surprising.

It sounds like you are going through an incredibly hard time - you seem to have got the normal increase in anxiety that everyone gets in pregnancy but you've got a massive overdose of it (is it cortisteroid?).

Have you tried cognitive behaviour therapy because it sounds like you have got into a cycle of really destructive thinking and once in it - like a big black hole - you can't escape and the thoughts get worse and worse and more and more negative. Wouldn't CBT help? Have you tried it?

The trust I am in doesn't prioritise pregnant women for CBT (against NICE guidelines) so I am on a list, but of course, due to the late diagnosis and referral despite my early request, I won't get NHS therapy before I give birth.

I am paying for a private therapist at the moment, but there is no one with full CBT accreditation in my area. Just started that today with an initial assessment session, but she doesn't seem to be very CBT more general psychotherapy.. so we'll see.

The psychiatrist says that CBT in pregnancy is often not as effective as when the baby is born. Not entirely sure why ... unfortunately, everyone I've spoken to seems to agree with this, including Dr. Fiona Challacombe who is one of the leading experts at the Maudsley on this sort of thing. The general consensus seems to be that it is actually pretty late in pregnancy to be trying to deal with this sort of thing ... you can imagine how frustrating this is when I flagged it up so early and the psychiatrist, in some ways, has been quite downbeat, really not giving me a lot of hope that it can be resolved though he does hope the meds will take the edge off things within about 6 weeks if the dosage is right.

The counsellor today said that we would need to focus on a) helping me make a decision that is comfortable about the birth and b) also trying to give me strategies to deal with the uncertainty in the short term. It's sort of tricky I guess because in some ways the OCD and past experiences make me sort of try to counter the negative thinking by telling myself that I can plan it and that things are positive when I don't really believe it deep down... so I can do a lot of CBT type stuff e.g. rationalise why my thoughts are faulty and replace them with more positive thoughts and images etc but the disconnect between my heart and my head is such that I can talk the talk but not walk the walk. It doesn't feel right, so I become a bit compulsive with it, having to "redo" the exercise over and over and doubting that it is working etc.

This is one of the reasons the psychiatrist has suggested I won't see a great deal of improvement quickly, because I am not in the sort of situation that some OCD sufferers are when first diagnosed where they were secretly terrified they were deviant or mad and just getting the diagnosis and knowing others feel the same way gives great relief. I'm kind of at a thorny stage where I know it, I get it, I can do bits.. but it's not quite working as it should because I don't really trust the process or believe change is possible. It's all positive and very possible to rectify in the medium to long-term but short-term, the prognosis isn't amazing because some of what I need to do I can't? E.g. I should be working at letting go and walking away from trying to hyperplan my birth, taking it one behavioural step at a time, working up a hierarchy of fears, but actually, birth is top of my hierarchy and like it or lump it, it is coming and coming fast. So I sort of HAVE to plan for the birth because ds needs to be taken care of etc, and the risk of a psychological breakdown is real and imminent, not just some illogical maybe..

I wish I could just turn my sodding brain OFF! .

Ummm, something like hypnobirthing affirmations? I used to fall asleep listening to mine... It might just help you relax in the short term (something to displace the negative thought pattern?) but at the very least surely won't do any harm and might be worth a shot...?

Hi thunk, I can't add much more to the other posts except also to say that it's great that you're addressing this frightening situation. I'm professionally involved with mental health issues and frequently see mums who have suffered some sort of post-traumatic stress connected with birth or which is ignited by birth. For what it's worth, it might be an idea to look at Mindfulness Based Cognitive Therapy which is enormously helpful for post-trauma. Look for anything by Jon Kabat-Zinn and the book that I always recommend is The Mindful Way Through Depression by Mark Williams and Jon Kabat-Zinn. You'll find it on Amazon. Ignore the fact that "Depression" is in the title - it works brilliantly for anxiety, stress and physical pain. There's a CD included and you follow an 8 week programme which should lead you nicely to D-Day! All the very best.

Hi Thunk,
I really feel for you. Anxiety and fear and brain going round and round fear and anxiety is a really difficult position to be in. I suffered with OCD for over 20 years (from about age 8 - 30 years) and still have tendancies towards an OCD way of dealing with situations I can't control. But generally I can now manage it...... so I wanted to say:
This time will pass and you CAN get through it and get to better less anxious times.
I too knew all about OCD so didn't have any of that initial relief some people get when they first seek help. But you can STILL beat it, and reading more books (like Maitri suggests) and speaking to experts and continuing to explore and discuss the issues can still help in the end. It just may not be the quick help you need.
Given your anxiety is current and real and given you can't switch your brain off (I have wished that too) can you channel your anxiety/OCD in some way. For example, I had OCD rituals that took up so much time, and at one particular time of anxiety/fear I decided that my rituals were making things worse not better. So therefore it somehow changed from: If you tap this door 20 times everything will be ok.... to: if you manage to resist and don't tap this door 20 times everything will be ok. (I don't know your version of OCD so this may not be possible. And anyway, even for me it only worked breifly - but did give me a few weeks relief which at the time was quite an achievement. I tried it again at other times and it didn't work so not sure about this, but its just a thought...).
And my last suggestion is to pray. I obviously have no idea about your religious background, and I'm really not a religious fanatic myself. But I find there is something clear, simple, and straightforward about praying. Rather than trying to control my fears, deny they exist, hide from the fears etc etc getting on my knees and praying makes me label them, acknowledge them and then ask some higher being for help with them. I find this helpful (as otherwise what am I supposed to do with the fears? where are they going to go? how do I get them out of my head?) and I wonder if this could be helpful even if you don't know to who or what you are praying.
Sorry for long post. The main thing I wanted to say is that you sound like a very impressive person, facing and trying to tackle your fears (but let down by the system/referrals etc). You sound like you are having a tough time, but you CAN get through this and come out the other side. XX

Thanks for all your messages.

I am going to do hypnobirthing classes starting the week after next and see if that helps. I am also trying to keep busy and divert my obsessional energy into "normal" obsessions e.g. getting ready for the baby. That's been hard for me to do this pregnancy because I was avoiding thinking about it, but I've decided that the only way to overcome that it is to stop the avoidance so I am doing all the double buggy research and that sort of stuff that is more healthy etc. I am still battling thinking all the time "but this will never happen of course" or thoughts of having to give the buggy back "when the baby dies" and then revulsion at thinking these things but I am trying to recognise this as OCD thinking and not actually real. Not sure about prayer Ktef, I had a Catholic upbringing and by nature Catholic prayer is terribly compulsive and it is something that can be counterproductive e.g. finding myself having to say a decade of the rosary every time I cross the road etc, and then a decade (our father, 10 hail marys and a glory be) suddenly isn't "enough" but double buggies will do ;)

Does anyone have any thoughts about what the best type of birth would be? I am afraid I am being very much a "good girl" about wanting a natural active birth etc etc just because I am afraid of asking for a more medical option like an induction. Would I be better off with a more managed birth so that I didn't have all the fear of going overdue or should I really convince myself about the active stuff? I am very confused (and obsessive - what a surprise!) about it. What would a non-OCD mum do?

Do you still have troubling thoughts about c section or is it more labour and natural birth that you have worries about? I'm planning a home birth because I'm really scared of not being in control and being pushed into decisions I don't want. I booked a homebirth early on but since then I have struggled with antenatal depression, the worst times being between 20 and 30 weeks, and the thought of having a homebirth has really helped me feel more in control of everything. I know I might need to transfer in labour but I feel like this would be more bearable as I would have spent the least amount of time in hospital. If your worries are more about labour then I would say c section would be the way to go, but could you ask about a private room and extra support afterwards while you are in hospital, to ensure it is under your control as much as possible and the stresses are minimised?

Hey hun, I also suffer lots of MH issues (although no experience of oct). Is there anyway you could afford to pay for private therapy/CBT? I think it would be worth it. Plus a therapist might be able to help you work through your choices for birth.

I totally understand your wanting to be a 'good girl' and make the 'right' choices. Again, this might be something a therapist might be able to help you with. I know it can be expensive but I reckon it'll be well worth it :)

Be kind and gentle with yourself hun xx

Hello Thunks,
Just read through and am stunned. What a messed up childhood! I feel so sad for the child you were never able to be. :(
Sounds like you were more parent than child on many occasions.

I just wanted to add my thoughts as someone who was massively traumatised by first childbirth experience. Second was far more palatable, ending in EMCS, which was really fine compared to first.
Have just had DD3 by elective CS as couldn't consider a repeat of the first and both times the baby has stuck in my pelvis.
Electives are peculiar as you have a known date, so have the capacity to focus unhealthily on the possible outcomes. On my planned date there were a load of emergencies so I was waiting all day and eventually bumped onto the next day. That increased my stress levels massively. I don't consider myself to be a particularly stressed individual, but I found the build up terrifying.
My emergency section seemed like a walk in the park in comparison. Probably because I had no time to dwell on the 'what if's.
That said, the actual procedure was fine. It was quick, there were thorough explanations of the process and risks etc and I am obviously still here to tell the tale!
Just wanted to present it from my perspective in case it helps. I wish you the easiest birth in the world. If you have any questions, please feel free to ask.

Thanks for your responses.

I am still very confused. I am on sort of psychological boot camp here at the moment (!!) with hypnobirthing, CBT, the psychiatrist and mindfulness meditation-based therapy too (recommended to me by an OCD specialist) and to be entirely honest with you, still feel clueless.

CBT lady thinks ELCS seems to be what I want (not sure)
Community midwife thinks that I am not suitable for a homebirth but hospital thinks this would be best
Psych thinks it does seem I have some PTSD about my first birth as well..

I just can't trust my own opinion here and it is becoming the focus of my obsessions.

The psychiatrist said the most important thing to focus on is realising thoughts are just thoughts and that there are no moral implications to how I prepare for birth.. but this doesn't really seem to help my anxiety.

I have been to see the baby on a 4d scan today which was a major step forward for me as I have been avoiding thinking about the baby being real in case something terrible happens . It was fine and I didn't freak out and it was nice to see the baby moving around and have some reassurance s/he is doing well in there.

I think the idea is that I need to stop trying to "fix" the birth.. but I don't know how and I have spent so much time this week either agitated, exhausted, crying or in a state of panic it is not funny.

Thunk been reading this with great interest, i started a thread on elc or normal birth to ask people who have had both what they thought was best.

My first labour was physcially OK apart from a tear, but every minuete I was mentally traumatised by what could go wrong. I was the only one out of my friends to have a normal and safe - text book birth. Between them they had all the problems that can happen. It didnt matter though that mine was fine, the fear I felt was too much and this time round I am going to be pushing for an elc. I had alot of trauma before the birth due to a close family loss, and mentally i found labour too traumatising.
Mental suffering doesnt seem to be factored in when trying to choose.
You obviulsy have alot of issues there but for the fact that no one can tell me my second labour is going to go well, I will be going for an ELC!
PS All my friends had awful labours - ending in all sorts of scenarios but they and their babies are all here to tell the tale, we are very very lukcy to live with such incredible medicine to help us!

It is definitely a control thing, but I am torn between whether it's okay to give into this or just giving into (and strengthening) the OCD. I am realising with even the few bits of therapy that I have had so far that I compulsively reassurance seek so I can't work out if any solution will make any difference, as I will worry about what will happen no matter what.

In an OCD book, it says to remind yourself that the problem is not that x or y or z will happen, it's that you WORRY that x or y or z will happen. It's the worry is the issue more than the event.. so far, so good.. just don't know how to fix that! And wondering if going for an elcs is just buying into that worry.

On the other hand, birth is very unpredictable..and I don't know if I am really ready or strong enough for it!