Petrified of Birth

[Pegasus1234]

Hi,

Im new on here. Im 21 weeks+ and this is my first baby.

I met with my consultant today for the first time. I am consultant led because of fibroids and previous overactive bladder problems for which I was under the gynaecologist.

I explained that I was terrified of giving birth and wished to be considered for C section.

I am not too posh to push, just have an absolute deep rooted fear, it makes me physically sick, cant sleep due to anxiety etc. Having nightmares. I also have personal reasons I wont go into going back to my teens.

I felt totally indimidated there were 4 people in the room in total all staring at me, judging me.

The consultant basically didnt listen to me, and asked if a tour of the labour ward would help!!

Being a health professional myself I explained that I knew exactly what was involved. I have observed both births and c sections as part of my nurse training.

He said they dont perform sections for women without a medical reason.
I would have thought that fibroids, bladder weakness and absolute fear would be reasons.

Im not a particularly confident person, and make it difficult to have my voice heard sometimes. I just felt I was being dismissed as a silly woman who needed to go home .

I feel helpless, so upset and alone.

Can anyone offer any advice, or has been through a similar situation.

Thanks

RockChick,
I can see that you want to help the OP, especially as you had good experience with counseling, but everyone is not the same and people have different attitudes to counseling and willingness to be "healed" is maybe the most important thing.

As you said, both possibilities have risks, but everyone weighs the risks differently. There are simply things that seem much scarier about VB than CS to me or the others that might prefer CS. And I doubt that they can be forgotten or suddenly taken lightly after a few sessions of counseling because they are very real risks, not imaginary or irrational like in the case of some other phobias (fear of buttons or toes, to name a couple).

So you don't believe it's possible to cure a fear of flying for example, as there are real risks involved there too? Of course it won't work for everyone, but all you are doing is guaranteeing it won't work if you won't even consider the possibility!

thunksheadontable,

I would in fact love someone to explain what underlying issues that could be that make women scared of humiliation, loss of personal integrity, pain and long term health issues. Maybe survival instinct? Sorry, I just had to. ducks

No, really, would anyone think of a MAN as irrational to be scared of such a thing? Would they send him to counseling?

PixieCake,

good idea to send it in writing beforehand. BTW. how come that you didn't have a CS in the end? You don't have to answer because I'm hijacking the thread already, but I really wonder.

RockChick,
I think that in general it is very difficult to fear phobias, even the very irrational ones. I'm not an expert, I just go by what I've read about it. However, if the person wants to be cured, it helps a lot.
I just don't believe that you can be "cured" out of wanting a CS, because that is usually just risk assessment based decision. If you want to have a biological child, it has to come out somehow and luckily nowadays, you have actually a choice, even though some OBs and MWs are trying to take that choice away. So I choose CS.
If I lived couple of decades ago, I would probably end up dead quite early in my life, so I wouldn't even have to think about how I should have my child.

*to cure phobias

of course, sorry!

Raluca, the risks of cs are also very real.

The point is that giving birth is frightening, and in all situations, can make a woman feel humiliated or that they have lost personal integrity and involve pain and may involve long term health issues. There was a horrific story here a few years back about someone whose cs went very, very badly wrong and I guarantee you that she experienced all of that and more. There are some women who find vb an absolute doddle. There are some who experience what you fear.

Whether we like it or not, pregnancy and childbirth can be pretty barbaric for everyone who undergoes it and yet for others, whether they choose vb with no pain relief, have an induction with every drug going and masses of instrumental intervention or a cs, it is straightforward and they are recovered within days. Part of entering into having a child involves an acceptance that the uncertainty around all this stuff is a reality for women and it's not for men, that's a fact of nature that can't be overcome (at least at this time!).

Vb doesn't actually have to involve those things that you are afraid of BUT there is no way of knowing. Unfortunately, I believe no matter how you choose to do birth there is no way of knowing there will be no catastrophic complications. It's one of the most dangerous times in a woman's life, and very unpredictable. Pregnancy itself can cause perineal and rectal trauma, for example, even if you had a cs scheduled from the moment of conception! Why do some women sail through while others have these unbearable experiences? Who knows?

Counselling, as I said, is to work out what makes a certain type of risk unacceptable to you. It is also NOT about "changing your mind". It's about exploration. So, to paraphrase TS Eliot, at the end of all your exploration you might find yourself where you started but perceive the place in its entirety for the very first time. However, I really do think that it's not entirely rational to have this tremendous fear or certainty that birth is going to be a particular way (either that it will be an amazing spiritual experience or that it will be a catastrophe).

And I say this as someone with perinatal OCD, so believe me my appreciation of risk is finely tuned. FINELY tuned. There isn't an obstetric risk I couldn't quote to you these days.. but the end of all my obsessing and crippling anxiety is that I do believe there is just no controlling all of this.

^^ what thunks said, so much more eloquently than I could have!!

So you don't believe it's possible to cure a fear of flying for example, as there are real risks involved there too?

Erm the risks of flying are statistically incomparable. A lot of the fear of childbirth is irrational. But some of it is very rational and understandable indeed. And it depends exactly on what you fear is about and how in manifests itself.

When you start looking at risk, you have a 1 in 4 chance of a c-section and a 1 in 8 chance of ventose or forceps. If you are in a higher risk group such as being over 35, you could be looking at 1 in 3 chance of a c-section. Obviously operative births carry a much higher risk to you and the baby. For some women, a c-section could be a toss of a coin or even less.

It also depends on what you feel is acceptable and not acceptable really as a risk.

Some women have big issues with being 'exposed' or not in control of the situation so to speak due to sexual abuse or rape for example.

I really do not think comparing childbirth with flying is a good comparison for this reason. In fact I think its pretty insulting and lacks any understanding of what the fear is about for a lot of women.

I don't doubt that hypobirthing or therapy works for a lot of women. But I don't think it does for a whole bunch too. In fact there is a Swedish research paper from September last year which was a pretty large study that concluded that even after counselling women with a fear of childbirth fared far worse in terms of outcomes than women who did not have the same fears. They concluded more research was needed and different methods of managing fear needed to be studied to see if any were more effective than others.

So please don't make out its some how trivial or on a parr with something like flying. Its not.

Meant to say about EMCS being much more risky than ELCS somewhere in there too.

thunksheadontable,
I can understand what you are saying about unpredictability of it all and I agree. It is unpredictable both ways, but why women shouldn't be able to choose which set of risks they prefer? Why anyone assumes the right to choose for them when the risks are equal?

I trust in my "common sense" or instinct or whatever you might call it. I have known myself for more than 35 yrs and have been through some counseling to explore different issues that has been very helpful. I know my health and know what usually helps me and what doesn't and what has a potential to go awry in the future. This is what is the "underlying cause" for me.

"I don't doubt that hypobirthing or therapy works for a lot of women. But I don't think it does for a whole bunch too. In fact there is a Swedish research paper from September last year which was a pretty large study that concluded that even after counselling women with a fear of childbirth fared far worse in terms of outcomes than women who did not have the same fears. They concluded more research was needed and different methods of managing fear needed to be studied to see if any were more effective than others."

And this is also mirrored by quite a lot of the research on anxiety disorders and antenatal depression, sadly..

I informed the community midwifery team of the fact I had experienced severe anxiety in my last pregnancy at about 6 weeks pregnant. It took 22 weeks before I got a referral to the Perinatal Mental Health Team where I got a diagnosis of perinatal OCD. NICE guidelines say that as a woman who is pregnant I should be prioritised for CBT, but that doesn't happen in my trust so I paid for twice weekly sessions myself instead. And The Dreaded Hypnobirthing.

Unfortunately, the reality is that there are issues with the fact that CBT works on challenging irrational fears and certainly, few of my fears are irrational. Many women with perinatal OCD, particularly postpartum, fear things like intentionally throwing their baby out the window or putting them in the microwave, and these things are readily challenged as in reality women with OCD are not a risk to their child at all and simply have a hypervigilant response to potential threat.

However, my obsessions, anxiety and fear are primarily about obstetric complications, stillbirth and, after birth, SIDS/other illnesses that might kill the baby. The extent to which I obsess is also about having an elevated, OTT response to threat, perhaps triggered by being sensitive to hormonal fluctuations the way some women are sensitive to pollen while others are not. Not one of my obsessions is, strictly speaking, irrational (especially if you think 1 in 200 babies die after 24 weeks, 19 each day). Yet it is not normal to be flooded by thoughts and images of these terrible things happening despite the fact that these fears are not irrational, and it is hard not to be distressed by them.

None of this means I shouldn't treat the fact my mind responds in this way to being pregnant.

Treating my anxiety has been hard, and I know that the fact I have experienced such extreme anxiety will ultimately increase my risk of obstetric complications, unfortunately.... but it was still worth looking into and trying to manage, I believe.... and it has given me much greater insight into just how unbearable I find uncertainty, where this need for control comes from and how it plays out in more subtle yet still not fantastic ways in other areas of my life.

Will any of this change my birth? How I feel about it afterwards? How I respond to any trauma I experience? I don't know. I just know that sometime in the next two weeks, I will have this baby I have carried for 39 weeks and 3 days and that this will come and go no matter how it happens in the end.

Raluca, I certainly feel women should have the choice and I would always support that choice.

I had had counselling in the past myself, and I pretty much started as you were, thinking what's talking going to do? I know why I think this way, I know why I feel this way. However, it has been helpful.

I think if you want a cs, go for it and argue for it and get it, you know what will work best for you. I was simply saying you shouldn't assume that others who don't agree or choose to handle the same fears differently to you are being irrational or not using their common sense. It really is a case of horses for courses.

Thunks above all else, I think expressing a deep fear of childbirth needs to be treated as a risk factor, on a level with any other physical risk factor as the research bares it out as a problem for both birth and post-natally.

The fact it isn't by a lot of HCP is the scandalous part and only serves to feed the anxieties of a lot of woman.

What we need to remember here is that every woman is different, every pregnancy is different and every labour. Everyones hopes and fears and expectations are different, and pain thresholds.

Some women will breeze through pregnancy and embrace and enjoy it and want as natural birth as possible. Some find it an empowering experience and want to be in total control and in tune with their bodies. For these women hats off to them. Others need all the help they can get! I fall into the latter category.

I totally agree that hypnobirth and the alternate therapies work for SOME women, just Not for me. I wouldnt even consider it beause I know it wont work. It would be pointless and a waste of time, effort and money.

Sorry to be cynical for all you alternative converts out there. I believe this stuff works depending on the type of person you are, I think you have to be quite strong mentally and really have a belief that it will help you through.

I have compiled my letter to the consultant, its long, very long, but I believe it states everything I need to put across. I have also asked for an appointment as soon as possible with him, as I cant wait til Im 30 weeks. I will be 23 weeks nxt Monday. I am sending it off this afternoon, but have just found out he is on annual leave this week arrrggghhh.

I live in Wales btw.

I think a number of people have mentioned cbt. Cbt is not an alternative therapy but a scientifically validated therapy for anxiety of the sort that means you don't feel at all strong mentally about your fears, you may even have an official psychiatric diagnosis (as I do).

I think maybe a distinction should be made between knowing you don't want to try something and knowing it won't work. It might not work if you are not interested in it, true, but I agree with Anakin that all fear should be dealt with professionally and efforts taken to resolve it. At the end of that process, if someone wants a cs that is absolutely the right choice.. But given the risks of all options I don't really understand not engaging in exploring these and assuming one option (which entails fairly major pain and some significant risks) is definitely best?

Thunks, depends on the individual.

I personally, would consider having to go through counselling as retracing things I already know and not really listening to how I felt and why I felt that why in the first place.

I would feel a pressure that, even if it wasn't the case, CBT was trying to somehow 'cure' me, when perhaps thats not what my fear is about or why I've made the decision that this risk is more acceptable than that risk. Not to mention you still have the thing that the goal is ultimately to make you 'strong' enough be able to go through a VB as the logic for undergoing CBT in the first place. Which I fundamentally disagree with the unspoken principle that an ELCS is a less preferable option in some way or other. I don't think its unbiased in it nature because of that. Not to mention the process of going through a counselling proceedure like CBT also has the side affect of potentional 'failure' if the CBT does nothing to ease your fears in the way you had hoped.

But most of all I just feel I would find the process distressing in itself, which I don't think would be helpful if I were pregnant. It would just add to my anxieties. I have reasons for wanting to just avoid any anxiety at all.

For me, its about looking at my risk factors, along side what I feel the worst possible outcomes and experiences would be for me, and then picking the one I feel most comfortable with. I pretty much see it as a choice between a homebirth and an ELCS. But a lot of my anxieties and concerns rule out a homebirth as an option for me.

I really don't feel I need to have counselling to be able to that decision ultimately and I find it frustrating when people say, "well you should just try it". I just feel it misses a lot of the point for me, and is slightly patronising in suggesting that perhaps I haven't considered a whole pile of different options. It really isn't a journey that I've suddenly woken up to and had to deal with because I've found myself pregnant. This is one thats been years in the making and has delayed even thoughts of having a family for a long long time and one I'm still trying to make.

Pegasus put it best in saying "We are all different".

I don't think that the goal of CBT is to "cure" anyone of anything related to VB, actually. It's a pretty broad treatment used for quite a lot of stuff. It's based on socratic questioning, looking at how thoughts, beliefs, feelings and physiology interact... so it would be perfectly valid to have CBT to confirm that a cs was the right choice. If, having explored everything, it emerged that you consistently believed, felt and thought that cs was right and this was matched by a calm physiological response then CBT isn't going to be about forcing anyone into a vb. It's the most logical, rational form of therapy about. It's also focused on the now, not necessarily anything to do with old ground unless that's where you want to take it. I would go so far as to say it really has nothing to do with easing your fears if those are rational, it's about ensuring that it all sort of "matches" e.g. that your thoughts, beliefs, feelings and how your body processes those are aligned. If they are, all CBT will do is confirm where you are at now but that in itself makes it easier to argue your case for whatever birth you choose as being right for you.

I've come across this on here before, that CBT offered in these circumstances will be to "persuade" or "cure" someone of a specific choice relating to birth but usually the person offering CBT really has zilch interest in what you choose or don't choose. It might be that you only have 1 or 2 sessions and looking into all these aspects just clarifies the strength of your thoughts, beliefs and feelings as they are now.

It is true that CBT does try to challenge faulty thinking, so if you were thinking, for example, that your fingers were razor blades then CBT would undoubtedly challenge it. However, as many have said there is a case to be made for any of the birth choices being right/safe/rational so there isn't necessarily an underlying "faulty thought". On the other hand, it's not particularly healthy or helpful to have unproductive fear either. I found CBT very useful in enabling me to be clear about the reasons I wanted to try for a homebirth/induction combination, which actually is not what the medicos would want either (and actually confuses the life out of them) but is right for me. Do I still need control? Yes. Am I free of anxiety and looking forward to birth? Not a bloody chance. However, I am very clear in my own mind about what I think, believe and feel about this and what it is I need to communicate to caregivers about, either at home or in the hospital. I don't consider it a failure at all.

I hesitate to say anyone "should" just try it, but I suppose I see it as no different to any other medical issue. I think if it were, say, cancer and I was offered three different drugs, I would want to look into each of them very carefully and ensure I knew enough to make the choice. To me CBT is a tool for clarifying your own thinking, not being asked to think another way, and that's what I don't understand as being threatening.

I had an ELCS for my 1st DC because of birth phobia (pegasus, I'm also Wales based, if you want to message me for any reason you are welcome) -

I've also had a fair bit of counselling for severe depression and anxiety, including CBT.

It can be very helpful. Sometimes it isn't. Sometimes it can get you a long way along the road from the point where you start, but still leave you a long way off the point you'd like to be. It is never a magic wand. If it was, no one with depression would ever kill themselves.

There is a structural problem with counselling, of whatever kind, being offered to women who have requested a CS, but not for example to women who are adamant they want a VB, or a homebirth VB. It inevitably ends up feeling like an attempt to dissuade you. For women who are requesting a CS NOT because of a phobia but as a rational decision based on reliable information, evidence and an understanding of their own personal circumstances, it's going to be irrelevant.

thunkshead, you've obviously had a very positive experience of CBT, which is great - but for someone going for any kind of NHS counselling or therapy, there's a HUGE variation in level of provision, as there is with so much healthcare. With such a little understood issue as birth phobia, the sad truth is that getting someone who knows what the hell they are talking about is by no means guaranteed.

In my own case, after being sent to see a perinatal psychiatrist (I was already pregnant), she decided that not only was counselling/therapy very unlikely to work - as in, to get me, in the time available, to a point where a VB was something that didn't cause me a huge amount of anxiety and fear, and was also going to be problematic for those caring for me. The risks included severe dissocation, which would have had a disastrous effect on my mental health, and on my ability to bond with my baby.

She also pointed out, in her letter recommending that I have a CS, that any therapy or counselling was inevitably going to cause me increased anxiety initially, and as the outcome of counselling could not be guaranteed, it wasn't the most sensible care path. It might potentially do more harm than good at that point. She also, interestingly, referred to birth as a process with an 'uncertain outcome'. Meaning that if I was persuaded to aim for a home waterbirth, for example, and then it all went tits up and I ended up with a 4th degree tear, or manual removal of placenta, then I would get a scenario that no one was confident I could cope with.

However - on a more positive note, I was offered support before and after the birth in the form of a couple of very 'light' meetings, to ensure I was ok and in a good place mentally and emotionally. I was given numbers to call if I had panic attacks, and they made sure I knew that I had people to talk to on the mental health team who were aware of my background, and had my notes, so I wouldn't need to 'explain myself' to a stranger, from scratch. As it turned out, I was fine! Maybe this was partly down to feeling so supported, and that I still had access to a mental health team even though I wasn't a candidate for counselling.

All this to say - yes, of course, counselling and therapy CAN be very helpful, as I've found before. But it's not a magic wand, it doesn't always work to the extent that it needs to, and there are circumstances where actually, 'give it a go, why not, what have you got to lose!' etc as an attitude, just isn't clinically appropriate.

For the record, I had an ELCS and it was fantastic. I was ecstatic, DS was very healthy (APGARs of 9 and 10), I had a very quick recovery (so much quicker than I had expected) and the whole experience was just wonderful.

All this to say - yes, of course, counselling and therapy CAN be very helpful, as I've found before. But it's not a magic wand, it doesn't always work to the extent that it needs to, and there are circumstances where actually, 'give it a go, why not, what have you got to lose!' etc as an attitude, just isn't clinically appropriate.

Totally, but to my mind there is a difference between having that discussion you had with your perinatal psychiatrist about why CBT/counselling wasn't appropriate for you given s/he knew all the ins and ous of your particular case and the approach and, before even meeting with or discussing it with any health professional, ruling out any investigation/exploration/intervention out of hand. That's why I likened it to different cancer treatments. In the end, a consultant oncologist might tell you about three but knowing your individual presentation only recommend one... it doesn't mean that the patient is necessarily best placed to make that decision before having a very full and frank discussion with appropriately trained and experienced staff etc.

Perhaps I've not been phrasing my intention here very well. Annakin said it the way I meant it: any fear of childbirth needs to be dealt with properly and professionally. For you, someone with specialist knowledge and expertise said CBT wasn't the right thing. For me, a cs wouldn't have cured my obsessions because they would have just moved onto something else as they themselves are the issue, not the actual method of birth.... in fact, this is pretty much what happened last time. I was obsessed with fear of stillbirth or the baby dying in labour, which literally just transferred wholesale to a fear of cot death and meningitis as soon as birth was over and done with. So if I had been granted a cs it wouldn't have been the end of my story and it would have meant I had undergone major surgery on the understanding that it would relieve my anxiety when it would have done no such thing.

The line between, say, your phobia and my OCD can be quite slim and I suppose I don't understand why anyone would discount all options out of hand without clinical exploration of any potential underlying issues. I understand what you are saying about how it is structurally difficult.. but I think if you are presenting with phobia/anxiety/fear that's different to just making a decision purely on the basis that your rational belief is that cs is, say, safer than vb.

Thunks,

and what if a woman doesn't suffer of tokophobia and still wants ELCS after weighing all pros and cons and her health, age, size of family she plans etc. Should she pretend she has it to get ELCS?

I don't doubt tokophobia exists and it can be harmful to women on daily basis, so some counseling could be advisable to ease the level of fear that actually threatens with panic attacks that are triggered by just seeing something on tv. That's a real problem and I agree that maybe it should be addressed, but only if the woman wants to be counseled and not as a means to coerce her into VB.

However, if a woman wants ELCS as a conscious decision, for instance if she is pregnant after IVF and doesn't want to risk anything happening to her very precious child, or if she is an "older mother" around 40 and is having her first and probably only child, do you think that you any amount of counseling can persuade her to go for VB? No, she will rather go private, if she can afford it, of course.

This is my problem with that more or less compulsory counseling because I don't believe it can really help such women in any way. And as fruity said, it can't probably even help women with genuine tokophobia.

I know that I don't suffer from tokophobia, I never had a panic attack or nightmares about being pregnant or giving birth. I just did my Maths and weighed pros and cons and ELCS is simply the best choice for me for many, many reasons. I know very well that it can go really bad too, but that risk is much higher for the mother than for the child which is important for me. I'd rather risk infection or even hysteroctomy than a dead very much desired and precious baby.

But then that's nothing to do with fear or anxiety really, is it? It also means you can demonstrate you understand the risks in a sensible and even graphic conversation if necessary. A friend had elcs after forceps and she was similar, she felt as they couldn't guarantee no further perineal trauma it wasn't worth it. I on the other hand find talking about risks difficult and it makes me tearful etc despite fact I am a very calm, logical person about most other things.

To my mind this thread is about tokophobia, not maternal request. Any fear that crosses over into phobia or obsession should be looked at by a professional with expertise to my mind.. for differential diagnosis etc. To me it simply boils down to the fact that if you are incorrect about your phobia and it is obsession instead that will transfer and so you could end up in a situation where you don't access correct support and are predisposed to PND and all that goes with it, just with a great big scar to show for it. This won't be true for all, but it seems sensible to rule out this risk which has its own consequences for a baby's development.

There are of course issues around a) understanding of and access to appropriately specialist mental health services and b) framing maternal request as to do with mh when it's not... but these are not the same issue.

Hi everyone, I'm new here but wanted to post and share my experience as I am going through something very similar at the moment.

I'm 21 weeks pregnant with my first baby, but for as long as I can remember I have been terrified of pregnancy and childbirth. I've also had depression as a teenager and believe the two are linked somehow. Despite my fear, me and my husband really wanted a family, and after having depression before, I weighed up that not having kids could cause me more upset and depression in later life. So we tried and I fell pregnant quickly.

I knew this would be difficult for me but I didn't realise just how difficult! I was a total mess before my booking app and hadn't felt so low since my teens. I was so worried that I would see the midwife and she wouldn't understand my fears and tell me not to be silly, at worst I was scared she would mock or make fun of me. I wont go into every reason now (as I would be here all day!) but I can only contemplate having my baby by c/s, due to being in control, knowing exactly what will happen etc. Anyway, I went along to the app and she was actually incredibly understanding, kind and compassionate. She recognised I have tokophobia immediately and referred me for CLC (she even picked a particular consultant who she thought would be sympathetic to me). She also suggested I see my GP, just to make him aware of my situation and he was also very kind, he did suggest an online course of CBT, not to 'cure' my fears or change how I feel about having a c/s, but just to help me and keep my depression at bay. I do need to spend some time looking into the CBT as admittedly I haven't done this yet, due to focusing on my consultant app etc.

Before my consultant app, I spent time writing down ALL of my fears and feelings, why I wanted a c/s etc. I wrote about 5 pages in the end, and at my midwife app before the app with consultant, she read through all of this and thought it explained my situation perfectly. I knew I wouldn't be able to cope with talking about it all with the consultant so I took what I had written with me. I had the appointment with him when I was 15 weeks. He read through everything, and then immediately agreed to my request for ELCS- he said he didn't see any point in trying to talk through my fears, as he thought it would only make me worse. He also agreed for the c/s to be done under general anaesthetic. After the app my consultant cc'd me in a letter he sent to my GP, letting him know my care plan and that my ELCS is booked for October. In the letter he wrote I was the worst case of tokophobia he had seen in 20 years of obstetrics so he must have taken me seriously!

One final thing, I think the consultant was able to agree to my request for ELCS so quickly because of everything I had written down. He said himself that it had been very helpful to read and he didn't think I would have been able to explain it all properly if I'd tried to just talk about it. I also really explained everything, my fear and phobia and the specifics of those, how it made me feel, how it affected my life and my husband as well, and about why I wanted a c/s. I also wrote that I knew about the risks etc of a c/s and I think they are more prepared to listen to requests if they know you are making an informed choice. I didn't even have to mention the updated NICE guidelines, I think they treated me so much as in individual.

I really couldn't have received better care from my midwife and hospital but I am still struggling lots day to day, which is another story! I just wanted to share my own experience, I really know how you must feel Pegasus and I hope so much you get the help you need. Happy to talk more if it helps as well xx

okay, thunks - I think you need to be a bit careful that you aren't universalising your experience here. You've explained very clearly and very well how you thought you were phobic but it was actually your OCD that was the main problem, and counselling helped you realise that.

(interestingly, I remember you posting very early on in this journey on this board, and I privately thought you didn't sound much like I did in terms of phobia - a couple of other times women have posted about phobia and I've thought BANG - that's exactly what I felt like....)

I just ask you to think about these things with an open mind.

Going for counselling or therapy during pregnancy when you have already been in the mental health system, and had some experience of talking about your problems, is one thing. Doing it for the first time when you are pregnant is something else. It can be much harder. And remember, getting people to go for counselling or therapy ANYWAY for any problem can be very hard. My GP told me, discussing depression and counselling, that around two thirds of the patients she referred to the counsellor never turned up for appointments.

And getting women to ask for mental health support for post natal depression can be very hard too. Why? They are too scared, they don't recognise what's going on, they feel they should be able to cope, they are scared they will have to be emotionally 'revealed' if they talk about it at a time when they just want to hide away. And so on.

Now, think how it would sound if someone said to those women, with PND - i just don't understand why you wouldn't ask for help. Why not?

It sounds a bit harsh - almost as if they were being blamed for something. Not for being ill in the first place, but for failing to do anything about it.

It really pains me when I hear counselling being talked about in an almost punitive way for pregnant women with birth phobia. 'you don't need a CS - go and get counselling.'

I've said time and again that counselling CAN be a huge help - but it can't be coercive. And that means forcing women to turn up in the first place. Add to that the problem that pregnancy has a 'ticking clock'! and it just may be be that any POTENTIAL benefit from counselling is outweighed by the risks of it not working. As was the case for me.

Can I just point out something a bit strange - counselling during pregnancy is only every mentioned on these boards as something women requesting CS should go for. I've read quite a few posts from women who are TERRIFIED of hospitals. No one ever says 'go and get counselling for your fears.' They are just told to get a doula/aim for a home birth. No 'facing up to their fears and dealing with it' - just avoiding it completely. Even when choosing a hb for say a first DC means increased risk of major negative outcome for the baby. It seems to be because a lot of women here see a fear of hospitals as being entirely reasonable! (now, I'm left thinking, so how the heck with they cope when their DC inevitably ends up needing a trip to a&e at some point...? but that's another story).

And we do seem to be in a very silly situation now where there is no distinction made between women with birth phobia requesting CS and women who a requesting one as a rational choice made with a calm and reasonable mind. The recommendation is that they are ALL sent for counselling. That makes me very uncomfortable.

ariel24, I can't tell you how encouraged I am by your post! In particular that you saw a sympathetic and aware MW to start with, who knew the best care route for you.

Encouraging too to hear that CBT is being 'recommended' to you rather than being something you are forced in to. Good work, GP!