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

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

I think you are misunderstanding me. My contention is just that it's complicated and individual but that really when you are talking about a clinical level of fear that should really be addressed by an appropriately trained and qualified person not that everyone needs CBT or counselling.

I just don't agree with self-diagnosis. I don't agree with it wrt any area of health or medical care. This doesn't mean I think everyone needs to sign up wholesale to what they are told by medicos, but it seems strange to just read some info online and then extrapolate from that that you have x or need y because you have z which I think happens a lot now in our internet age. I work in a different area of healthcare and I see a lot of it, and have yet to believe that self-diagnosis as opposed to becoming informed about your symptoms and the treatments for them, is ever a good thing.

From what you have shared, you knew your fear was problematic for you so you went and addressed this by seeking help etc, you were told counselling wasn't going to be clinically appropriate for you, but that's very different from someone self-diagnosing and then pushing forward for a cs that may really not be the right option. It also meant you had support around birth to match your needs from appropriately trained people as opposed to just being stuck in a neverending, demoralising and degrading battle with obstetric staff who might have discounted your fears.

I don't believe everyone needs counselling or should have to jump through hoops to get a maternal request cs or induction or whatever. It's a bit paternalistic and I don't agree with how midwives and obstetric staff inflate elcs risks on the NHS when discussing it without talking through the equal risks presented by other forms of birth. This is why in my mind the discussion around these fears - where a woman has disclosed serious and severe fear about childbirth, not just where she asks for an elcs based on her calculation of risk - needs to happen with someone with specialist perinatal mental health training and not just an obstetric consultant. Again, applying this only to where there is serious fear/anxiety, not for a maternal request that is not associated with these symptoms.

In some senses, I guess I think what you've said is a bit contradictory e.g. you said that when I initially posted, you thought it didn't sound like I had tokophobia as you had experience of it BUT how would I have known that? How does a woman who is having anxiety or panic about birth know what falls in the normal range, what is tokophobia, what is OCD etc without accessing professional/specialist support? I can tell you now my midwife and the obstetric staff I have seen wouldn't have been able to differentiate them... and so that would have made it even less likely I would have managed to argue for what I needed.

I see what you're saying about it seeming harsh to suggest women should seek help when they have these symptoms as if they were at fault, but fault doesn't enter into it in my mind AND I have been there with the shame/hiding etc. I had all of this last time and I admitted it to no one, but sadly, I ended up having to face the consequences of that both in birth and postnatally.

What I guess I am trying to say in FAR too longwinded a way, is that if anyone has any sort of health condition that they don't address, there will most likely be negative consequences. Men who won't talk about symptoms of prostate cancer or bowel cancer because of embarrassment for example. It's understandable, it certainly wouldn't mean it was their "fault" if their cancer progressed further because of the embarrassment delaying treatment, but it wouldn't make sense to tell people it is okay not to see your doctor if you have symptoms of bowel cancer because it might be distressing to have those investigations? The sad reality is that if you hide something like PND (as I did!) then you suffer from it for longer and the long-term consequences are potentially greater both for you and your baby. I thought I didn't have PND because the information I found online didn't "sound" like me, because actually I had PND-OCD which presents a bit differently. So I struggled on.

That's the danger of internet self-diagnosis for you, I guess. Resources like MN are great but in the end of the day we all universalise our experiences and will look for the bits that suit us or match our thinking. I think in situations like these you need an objective professional to assess and give some advice and support. At that point, you can weigh up options in a more informed way.

okay thunks, maybe we'd better leave it there. I'm not sure I am expressing myself well and I don't know how useful this is to other people.

FWIW - I didn't seek help. I went to pieces in front of a MW at my first booking, in a way which scared me and her! She told me then and there that a CS was an option, but it wasn't up to her to agree it - I had to see a consultant, a consultant MW and the psychiatric team.

I only agreed to this as I had no other way of getting a CS. Based on my (fairly extensive) previous history of counselling and therapy, I knew that a couple of months of counselling (which is what I would have got, by the time it went into the nhs system) wasn't going to 'fix' me enough to make me simply have a normal level of anxiety about a VB. If you ask me how I could have 'known' - well, I had a pretty good idea is all I can say. A lifelong crippling severe phobia, which stemmed in part from very traumatic events involving sexual abuse and assault isn't an easy thing to deal with quickly. And having a deadline hanging over you really doesn't help. I do know CBT is about 'moving forward' and not raking over the past - but given that I've had problems in the past with triggers related to this abuse, and dissociative episodes, there was a strong concern that a 'quick fix' approach would be counter productive.

As it happens, the psychiatrist I had no choice about seeing was of the exact same opinion. I didn't state mine, btw - she offered this independently.

So I didn't 'seek' help - and didn't, in practice, access any of the help I was offered because I didn't need to ('but how could you have known you didn't need it??' - well, I just didn't. I never felt the need, and I was right. Nice to know it was there though).

Interestingly, re: PND, the psychiatrist told me that women who have suffed depression before tend to cope better with it because they recognise what is going on and are more likely to ask for help earlier.

I'm not sure what else I can add now. I would if anything be interested to hear your views on whether you think counselling should be offered as routine to women presenting with a huge fear of hospitals, or women with an absolute terror of caesarians. Or just women who fear a VB? after all, they are all 'self diagnosed' fears which women use to choose their birth options. as I've said - it seems we view a terror of hospitals or caesarians as being 'reasonable', but not a fear of VBs. I think that's at the heart of the matter, really.

Fruitybread, thank you, reading your posts and Pegasus' original post as well just made me want to share my story. I knew I wasn't the only person to ever have tokophobia but it can feel very lonely at times!

I really couldn't fault the care I have had from midwife, consultant and GP. We only hear the bad things so wanted to share something good.

I haven't had any CBT or counselling forced on me, if anything my consultant thought it would do me more harm than good. I have bad experiences of counselling as a teenager but everyone is different. Different things work for different people. I am still finding it really hard even after the ELCS being booked but they cant do more than what they have done!

So glad to meet others like me xx

Ariel, I'm really glad. I had a very good MW too - and consultant MW, who among other things helped me put info in my notes so that I didn't have to explain myself over and again to every HCP I met. This was a real blessing and meant preferences like 'screen up as soon as I have spinal in' could be followed. So I had no catheter in beforehand, it was all done when I was numb and couldn't see it/wasn't aware of it.

I try and post about my positive experience when I can as there as so many awful stories out there, where women are treated like ignorant children and put through totally unnecessary trauma.

I'm so glad you got the birth you wanted, and hope others like us manage it too. My consultant too kept hold of all my notes I had written so everyone who will look after me in hospital will know my feelings etc. That's why my advice for Pegasus and others (obviously just what worked for me) is to write it all down, every aspect of it, then the midwives and consultants can understand it better. If I hadn't written it down I wouldn't have been able to explain, I would have been incredibly upset and not able to explain myself or deal with questions and then I don't know if the consultant would have been able to agree to the ELCS immediately.

I think we are probably communicating at cross-purposes to some extent fruitybread. I think you seem to think I am saying everyone should have counselling when I am saying that everyone should have access to someone who can give their independent opinion e.g. psychiatric support e.g. a perinatal mental health team? So I'm a little confused.. because it sounds like you found the perinatal psych team helpful and supportive and understanding, but also that you don't think that it's good for people to access this? .

In terms of your question, I think psychiatric support should be offered to anyone who has any crippling fear of anything but I guess that my perspective is slightly different because the actual experience of fear itself is so much more of a factor for me than what I am afraid of, if that makes sense? I thought I was afraid of vb at the outset. Then a cs seemed to be on the cards, and I thought I was afraid of that. Then I thought it might be hospitals. So I booked a homebirth. Now I am afraid of that. So I booked an induction. And guess what? I am still afraid. I just don't want to do this. Tough luck I am due on Saturday, eh? .

Our histories are not dissimilar, either. I also have a history of sexual abuse in childhood and a rape in my early 20's which I had a lot of support from the Rape Crisis Centre for. I had a dissociative state after my last birth because of how it happened at the end.. and I am more afraid of that than anything.. but the issues for me I feel now (this may change!) are more to do with the uncertainty I grew up with. I had a very cruel, manipulative dominating severely alcoholic father and a mother who I am pretty sure now never really attached to me.. so no quick fixes here, either, I have to say.

Nothing will or could be fixed before I give birth but I suppose the difference between us is that elcs just isn't a fix for me either because I don't have a pathological fear of vaginal birth, I have a pathological fear of me or my baby dying somehow in this whole process. The fear is the thing... I need an epidural equivalent for fear rather than pain because really, I'm just scared of everything to do with this whole process. There isn't one bit of it that doesn't provoke reactions/obsessions/panic.

I think what counselling has helped with for me is less about the "cure" than about appreciating and having a bit of compassion for where I'm at with it, and it has reduced my twisting feeling of shame that as a competent, intelligent, decent woman who has overcome all sorts of hardship in life to get here and to flourish in everyday life that this is something I can't crack? It has helped with a bit of acceptance that this is where my mind is for now, and that I am just going to have to cross my fingers and get on with it and hope that it all goes well. I won't say that it is easy to say that, or that I fully believe it, but I am closer. Good days and bad days. Just want to make it to the end now and get on with it.

Incidentally, fruitybread, wrt abuse etc, who did you disclose this to? I had a meeting with the supervisor of midwives early on in this process and told her but she said that it was too private to discuss and not suitable to share on the birthplan.. but it sort of does make a difference to how I feel about things like stretch and sweeps, examinations etc... so I wondered if you had had a different experience or if the cs stuff really meant this was less relevant in your case?

To my mind this thread is about tokophobia, not maternal request.

The two are not mutually exclusive by any stretch of the imagination though.
In fact in my case they very much go hand in hand. And the research support the fact that women who request an ELCS do present with an above normal level of fear. A request for an ELCS is actually an indicator of fear.

Thunks - I don't think women should be forced to go for counselling, any more than I think anyone should be coerced into any medical treatment they don't want.

Now, I know you will say 'but I don't want anyone to be forced into counselling!' fine, and I'm sure this is the case - but there is a WORLD of difference between a GP for example saying 'there is a CBT course, here's a bit of info about it, I recommend it but of course the decision is yours' - and a mw saying 'I will refer you for counselling and you must see a counsellor before you can talk to a consultant about a CS'.

I'm afraid self diagnosis does come into things a bit there - although if you called it 'making a decision about your own care' then it might not sound so bad.

Re: my background of abuse - it was something that was mentioned in my notes, in a sealed envelope that also contained the psychiatrist's letter. So the info was there if needed but a little more 'protected' than open notes. It was very, very helpful that mws and consultant were aware that I had 'triggers' and could avoid them. I'm actually surprised your mw doesn't think people caring for you at birth need to know you have a sensitive background. maybe I've misunderstood?

The thing is, if you get a mw who wants to give you an internal, because that's standard procedure, and you say you don't want one - it's MUCH better if she understands that it may be traumatising beyond the average, IYSWIM. Otherwise there's a risk of the 'come on lovey' approach, where mws get brisk about things like exposing a patient, or doing an intimate examination. Women are supposed to 'leave their dignity at the door' remember - if people don't have at least an idea of your history, sadly you might not get such a sympathetic attitude.

I know where doulas help women birth who have had sexual trauma, they discuss clearly in advance what is likely to cause them a lot of anxiety. Or anger, or whatever the reaction is (part of my problem is that I am liable to lash out physically if I feel panicky. Not great for hcps, obvs).

So I had I suppose obvious issues about intimate exams, objects being inserted, legs being held apart - other less obvious ones like I HATE someone describing what they are doing to me AS they are doing it. Which was good for them to know as some mws/docs etc think that's a good thing and most patients find it reassuring. Not for me...

For me personally, a CS meant I was able to avoid almost every situation that was likely to 'set me off'. It really was a solution. I guess if I'd been very scared of surgery, say, it wouldn't have been, but I don't have a problem with that, or medical environments. Don't love 'em, but don't feel unusual anxiety about them.

I guess so Hmmm.. I suppose I just found that the perinatal mental health team were the only people I told about my fear who didn't make me feel like a silly bint who didn't know I'd been born and who I could really talk it through with, without feeling judged, dismissed, patronised etc. Everyone else just seemed to, well, speak to me as if I were a small child who didn't "get" that this was just the way things were and gave me the impression that I was coming across as a bit feeble-minded. Everyone else made me feel I'd lost my voice, as if I had no voice. It has been a very sobering experience, and has really made me feel for people who have ongoing mental health issues in their lives.

The perinatal mental health team made me feel like my fears were valid and that the most important thing was my health and wellbeing, not what the guidelines/hospital targets etc said. I'd like all women to have access to that service. However, I suppose I have to recognise that I am in an area with a Mother and Baby Unit so therefore with a high degree of speciaism in this area and not all women will have this experience.

Thanks for that fruity.. I have been concerned about that, and I was a bit surprised that this was the reaction I got. That midwife was the only person I've told... I was supposed to have an assessment with the CPN this week but she had to cancel, and I think it would have come through there.. it's just all a bit late in the day. I find it very difficult to talk about, and though my husband knows as he met me when I was still attending the RCC and was the first person I was with after all that, we haven't really discussed it in years either.. I think I have sort of gone back into denial about it because it's too painful and I like to think "dealt with" though I know it's not, really. There are just so many issues...

And honestly, I really realy don't think anyone should be forced into counselling.. but I do think that trying to sort it all yourself can be very difficult for most people regardless of how intelligent or rational or sensible they may be. You can still go against them! I was advised to take medication but I was too hyped up about the risks to be willing to do so at the time and they respected this without question... I'm sort of sorry I didn't now but that's another story!

So I am not advocating counselling per se (though it was useful for me) but an appointment with someone who understands the complexity of these issues and who doesn't have a personal target relating to reducing cs rates seems sensible to me.

I have yet to meet a midwife or obstetric person who has "got" it I'm afraid! I am sure from reading these boards that they must exist, I just haven't found them. There will probably also be crap perinatal mental health teams, but I suppose that you would hope that a consultant psychiatrist specialising in perinatal mental health should be able to differentiate what's within the normal range of fear from what's not, what requires a cs for psychological wellbeing and what doesn't etc etc. I did feel shame about having a "psychiatrist's appointment" but nowhere near the shame I felt trying to explain my thoughts and feelings to an unfeeling, unthinking and very naive obstetric registrar ("well labour is tough for everyone, sweetheart", and "I don't want to pressure you sweetheart, but you do have to make a decision about birth now because it's only three weeks away!" ).

It is all terrible really. I wish I didn't even know how to have this conversation.

Thunks it's been interesting reading your comments about a perinatal mental health team, tbh I was unaware these even really existed! I knew there was probably the option of counselling but didn't know from whom, and I have to say after my previous experience it wouldn't have been for me. But then I was also lucky that I had a great midwife who recognised my problem immediately and a consultant who was wiling to treat me as an individual wit no thought about hospital targets etc. He said he didn't see the point of counselling for me and but then he diagnosed my tokophobia so quickly. So I felt I already had support. It makes me sad that in some situations some women get pushed into counselling or CBT and it also makes me sad that those who want it don't get access to it.

Just wanted to wish you good luck with everything anyway and hope all goes well.

Thanks Ariel, it is good to hear that you got what you needed without a fight and without being dismissed.

I guess the problem with our system here in the UK is that it's such a lottery. I presume there are variations everywhere as different professionals take such different stances, but it does seem a shame that there isn't some more consistency in good practice whoever it happens to be provided by.

Your situation is how it should be. I would like to see more midwives and GPs on the ball, definitely. I had been to the GP three times and had my booking in appointment and mentioned the anxiety and my past history of anxiety/obsessive behaviours to all of them, and the primary care folk were really crap. Both GPs told me that they wouldn't recommend any medication, one of them while eyeing me quite squarely as though I were after some sort of cheap high! The other ceased to make any eye contact with me as soon as I mentioned the dreaded A-word. And in some ways, as a second-timer I think I was still listened to more than when I tried to communicate my concerns last time when I was clearly just a typically anxious first-timer in their eyes.

That's the thing, it really is such a lottery. I can't tell you how frightened I was before my booking app with midwife. I actually ran out of the surgery when I first got there and poor hubby had to drag me back in! So to find that she was so amazing helped so much. I honestly credit that woman with stopping me from having a total breakdown and as terrible as this is to say, I don't know how I would have continued the pregnancy without her and the consultant. It really has been terrifying and such a shame when it should all be so happy.

I guess so Hmmm.. I suppose I just found that the perinatal mental health team were the only people I told about my fear who didn't make me feel like a silly bint who didn't know I'd been born and who I could really talk it through with, without feeling judged, dismissed, patronised etc. Everyone else just seemed to, well, speak to me as if I were a small child who didn't "get" that this was just the way things were and gave me the impression that I was coming across as a bit feeble-minded. Everyone else made me feel I'd lost my voice, as if I had no voice. It has been a very sobering experience, and has really made me feel for people who have ongoing mental health issues in their lives.

You see this is where I feel slightly differently about things in the sense that I know I have a phobia, I know I'm not a silly bint because I've had the massive advantage of being able to research and make myself aware of the subject in a great deal of depth BEFORE getting pregnant. And this really more than anything is the message I try to get across to anyone who comes on here asking about this. They aren't alone and they aren't pathetic and actually there is a hell of a lot out there that proves i'm not.

In that sense, my approach is more about getting everything into place so that if anyone does try to treat me like that, they are going to get short shrift from my DH about their lack of professionalism and knowledge or to be able to go down the route where those things just aren't even an issue (go private).

TBH one of my triggers is precisely being treated like, due to previous experience with medical staff and the lack of faith I have in them. I've been told information I know to be not correct and am very aware about the way in which risk is presented being deliberate and designed to take you down one route. I very much need to feel fully in control and listened too. Fortunately I also have a BIL and SIL who are doctors who are able to confirm I'm not nuts on the research stuff too. SIL is a psych specialist too.

Ive had an emergency c section due to a breach baby getting in trouble, then my second child was a normal birth. I would have a natural birth over a c section any day.

I have to say that, I disagree with the idea of self diagnosis being a bad thing on this particular subject. I really think it has a key role to play with this particular condition because of some of the common patterns of behaviour associated with it. Certainly awareness of what an illness is and how it affects you is really important for a range of series conditions as it saves lives. I see this in a similar way.

In terms of "self diagnosis", being able to put a name to how I've been feeling has been the biggest step forward I could have made. Without that moment of realisation, I don't think that I would even be in a position of even considering the possibility of having children, and I would still be going around with the ultra defensive "I hate children" line. I think its a 'lightbulb' moment thing.

And thats the thing, with primary tokophobia, as women carry it around for a long time not being able to understand whats going on. Certainly in primary tocophobia it often starts as a child, and women are well aware that they harbour 'unnatural' thoughts about childbirth and feel unable to discuss it because its so taboo or affects their self worth as a woman.

Being able to "self diagnose" in this situation, opens the door for help. Even if the self diagnosis isn't completely right, I think empowers and helps people at least seek out support and information that they wouldn't have otherwise. You are talking about a condition where women can go to pretty extreme lengths to avoid becoming pregnant or terminate pregnancies that they want, as they are just unable to talk about the subject at all.

Suddenly you aren't a freak and suddenly you can express things in a way you couldn't before as it has a name and so has to be taken seriously rather than just being "hysterical and weak". Being able to say "I have a problem here, but I'm not unusual as its recognised" and then be able to rationalise it from that point, has certainly helped me enormously.

In recent months, I've been able to talk to close friends about it, and for DH to be able to explain to my SIL that, I'm not being rude in wanting to avoid her because she's pregnant/just had a baby, its actually cos I have a certain issue that I need to work through. In doing that I've got support and feel more able to deal with perhaps taking things another step forward.

The power balance between doctors and patients is often a really a huge part of tokophobia. Trust between the two is a very, very regular theme - and that means that, actually, counselling therefore can become deeply problematic. How can you talk to some one about your deepest and darkest, when actually they represent a large part of that fear in the first place? Imagine being afraid of doctors or completely distrusting of doctors in one way or another, but someone says "Oh well the only way you can solve this is to talk to a doctor"... I really do think this is an important piece of the puzzle that people miss. Its why offering assess to counselling is good, but to say, "I don't get why anyone wouldn't want it" rather misses a huge part of the issue.

When you start talking to women on here requesting an ELCS it very quickly becomes apparent, just how much homework some of them have done into the VB and ELCS debate. Many (like me) are obsessive about it.

At the heart of that is this huge mistrust of HCPs, how risk is presented and discussed, issues of consent not being properly respected or done by coercion. Many are shocked and feel lied to when presented with risks of VBs - women feel there is a lack of transparency. Ignorance of the subject of tocophobia or even a complete denial of the existence by some HCPs doesn't help. Which unfortunately is compounded by the promotion of the 'too posh to push' myth by the press (and the governments failure to follow up recommendations from 2003 to study why women make maternal requests in this country and to standardise how reasons for ELCS are recorded, so the subject can actually be studied properly. Instead we are left with Sweden, Norway and Finland leading the way and leaving us lagging behind).

And to pick up on something fruity said earlier - If you start reading a lot of the threads on this subject, I do think it is very easy to very quickly, be able to pick out individuals to whom the idea of a VB with support is more palatable and to whom the suggestion is liable to provoke a reaction of outright distress in. Its difficult to explain, but there does seem to be very clear patterns in the way people phrase things and the emphasis and importance they put on certain things.

From that point of view I do think that just letting women have an ELCS if they are that set on it, has to be done and even approaching the subject of counselling needs to be done VERY sensitively, and at arms length and with extreme caution.

I do think that if that is respected, it starts to rebuild bridges over trust, and make the woman more likely to seek help over surrounding issues surrounding that at her own pace and on her own terms. When someone is pregnant isn't necessarily the time to do it by any means, and I find it odd to even suggest exploring a lot of issues at that time. The ELCS might not be the ideal solution, but it definitely has a lot of merit in re-establishing faith in HCPs.

On a personal level, I find thunksheadontable's lack of understanding why wouldn't someone 'just try' counselling, slightly difficult to cope with. I have to say, I'm just left with the words "you don't understand how I feel" floating around my brain.

If HCP and politicians aren't doing their job in identifying and promoting awareness of tocophobia and ending the "too push too push" myth, then as the situation stands "self diagnosis" is actually the only way to actually gain access to care for many. Even Ariel's admission on this thread that she wasn't even aware that there was such a thing as a perinatal mental health team points to that.

HmmThinkingAboutIt I can relate to so much of what you say, I'm so glad I found this thread as I honestly felt so alone before even with the great care I've been getting. I guess really there's a certain amount of self diagnosis with any health condition isn't there? I mean I suspected I had tokophobia but in honesty, was careful not to use the word when talking to HCP's until they had diagnosed it themselves, for fear of them believing just that, that I was self diagnosing and was wrong! Sorry hope that makes sense. Luckily my midwife diagnosed it at my first app.

When I told my mum what was going on with me, she said she thought I was so brave that I'd actually been able to talk to the dr's and midwife about it as she wouldn't have been able to do this. As scary as it was I really didn't have a choice. I don't like to contemplate what could have happened if they hadn't helped, I don't see how I could have continued with the pregnancy. And my baby is very much wanted.

On a personal level, I find thunksheadontable's lack of understanding why wouldn't someone 'just try' counselling, slightly difficult to cope with. I have to say, I'm just left with the words "you don't understand how I feel" floating around my brain.

No.. my initial response was because some of the comments about hypnobirthing/counselling etc referred to these are being "irrational" or not "common sense" which had pretty much the same effect on me, to be honest, as though my attempts to deal with my own concerns and obsessions were somehow deficient compared to this immense certainty that some of you seem to have.

For obvious reasons, I envy you your certainty and also that an ELCS seems to be a straightforward resolution to your fear. Ultimately, I am afraid of just having to carry and birth a baby no matter how it is done so, well, what choice do I have when it comes to "just giving it a try"? My options were: a) medication (which I found totally unpalatable in terms of risk at that point of my pregnancy, probably because of the OCD); b) counselling or c) totally losing it and possibly being suicidal. Not such a fantastic array of choices there, let's face it.

The distress I have experienced has been incredibly difficult for me, incredibly isolating and extremely hard to keep a lid on. That distress is also, sadly, as I said above associated with increased obstetric risks and increased risks of harm for my baby and his or her development. Needless to say, this doesn't exactly fill me with joy either.

Bear in mind I am 39 weeks and 5 days pregnant and regardless of what decision I make, this baby has to come out. Any thoughts on this? What am I supposed to do with my fear given that every single aspect of the unpredictability of it all terrifies the life out of me?

My very reason for contributing to this thread is that I suspect there are others like me for whom ELCS isn't going to be a magic cure for the control issues, anxiety or distress caused by carrying/needing to birth babies. All these things you talk about, about trust and fear and anxiety and feeling alone etc, they apply to me and to women like me. Of the professionals involved in my care, I have a trusting relationship only with the ones who, paradoxically, will have nothing to do with providing care for me in birth. I just don't have this sense of trust about the care provided wrt ELCS that can overridde my lack of trust with relation to pregnancy care, or care in terms of vb etc. I don't trust any of them. I don't trust my body. I don't trust the baby knows what its doing. I don't trust fate. The only shot I have, really, is accepting that their trustworthiness is not the primary issue here, it's my sense of worry about their trustworthiness and I really don't have a hell of a lot of choice about managing that worry other than to try to mindfully accept it.

So, for many of you, I have learned that counselling isn't going to be clinically appropriate. However, that does not mean that it is going to be helpful for everyone to rule it out at the beginning of the process because it seems to be of limited use in relation to primary tokophobia, say.

Someone told me not to universalise on the basis of my experience, but I think that probably applies to the issue of whether counselling can help with fears around childbirth.

I have also said in several responses now that what I want to see is women having access to respectful care where that differentiation can be made... and I have repeatedly said it's not about counselling being a cure, it's about recognising that for some women, the issue is not going to be tokophobia and that it can be helpful to have access to people with the specialist knowledge to provide them with an alternative diagnosis when they get that CS date and find they are no less panicked than they were before.

Thinks so sorry to hear how hard it's been for you, for you trying to decide what to do must have been impossible. I have also found that even after my ELCS being agreed, I have still been frightened, as now my big fear is not making it to 39 weeks when the c/s is booked for. So my panic hasn't gone, and I struggle to cope with it. It has caused many arguments with husband who has been amazing but doesn't know what to do now.

I dont think I will have a resolution until I hopefully wake up after c/s and they give me my little girl. I just keep convincing myself that she will come early though.

Ariel, can you get it agreed that if you go into labour early you will still get a CS? I know a friend who had this post-PTSD and it was immensely reassuring.

The doubt and the uncertainty is part of the nature of anxiety/phobia and related conditions etc.

Sorry, cut myself off there! AND A TOTAL PITA. I can't wait for this next bit to be over. I am just exhausted with thinking. I wish I could turn it off! Though it is helpful to at least have somewhere I can let it all out... and it can be challenged a bit.

Yes I have a letter from the consultant stating that if I go into hospital in labour in late third trimester (I think midwife said late 36 weeks onwards) then they would do c/s. They only wouldn't do it if I went into very early pre-term labour. Which I am convinced will happen. And I worr that even if I get to 37 or 38 weeks I will get to hospital and it be too late or they will be too busy with emergencies. You are so right that its all part of the phobia, it seems relentless! I keep thinking the same thing, I wish I could turn it off.

Ariel, I think for women who have been 'granted' a CS that they very badly want, the fear of things kicking off before the planned date is very common and entirely understandable. I don't think that means you don't want a cs, btw - sounds like the opposite in fact. For women who have begged for a cs because of previous birth trauma and feeling out of control, then thinking 'aargh! just let me get to my cs date!' seems to be a universal theme.

best thing is to make sure you have a protocol agreed with your mw, so you have a plan if you think things are starting too early. It gives a little more peace of mind. It happened to me, and I had a plan, and I was totally fine, they just fitted me in earlier! (meant I had to pack a hospital bag very hastily though, so that's one thing I'd advise you to do, although you are probably better organised than me anyway).

Thunks - please don't feel 'got at'. You've obviously had/have a lot to deal with, and given you are over 39 weeks, I'm sure it all feels even more 'present' than ever.

I do take your point that some women may be asking for a cs when in fact it isn't necessarily what they really want - perhaps based on a lack of understanding about the process, or their own fears.

But please hear me when I say that for those of us who DO know it's what we want, and who aren't confused about the issue, then we really, really, really don't want to be treated as if we don't know our own minds. Or have to 'prove' ourselves before we are granted a cs.

Perhaps the best compromise I can think of, in an ideal world, is for women to be told they CAN have a cs if they ask for one - but if they feel that this hasn't allayed their anxieties, or they are as scared of a cs as a vb, then they are offered help in finding other ways to deal with their fear.

I remember a thread you started a little while ago, where you commented about a cbt therapist you had been sent to about your birth fears, who I think (sorry if I got this wrong) had said something along the lines of 'you should have a cs' to you. (I think I remember commenting, saying that this was very unprofessional behaviour from a therapist, to advise you one way or another). In any case, the thread brought down the wrath of many mumsnetters who are very anti-cs, and - with all due respect - I felt this was part of the value of the thread for you. That you didn't want a cs, and you wanted 'back up' or validation for this view. I mention this because (a) I REALLY hope you aren't still seeing the same therapist! and (b) I can see that you have been on a huge journey in terms of your attitude towards cs, and I hope you can see that part of that has been the fact that it looks as though hcps would actually have given you the go-ahead for a cs had you actually wanted one.

I'm just saying that if women are given a CHOICE from the outset when they express extreme anxiety about birth, surely it gives them the best chance possible to work out if that is what they really want. When someone wants one but is made to jump through hoops, have distressing and often bullying meetings with consultants, and often left until 37/38 weeks before they are given a definitive answer either way, then they have to focus on trying very hard to get that CS. Such a negative and coercive approach means women are spending time and energy battling outside forces rather than spending time thinking about themselves and their feelings.

I really do take on board what you are saying about realising cs wasn't the right choice FOR YOU - but surely you would have had a much harder time working that out if from the outset the attitude from your hcps was that you couldn't have a cs, regardless of how you felt?

Fruity it's been great for me to hear of your experience, I've never met anyone before who has been in this position so it helps to hear from someone who has gone through it.

They say they will do emcs if it comes early but I still worry so much that for whatever reason they wont be able to. They will be too busy, the labour will progress too quickly, I won't get there in time etc. I have been imagining some awful scenarios about what I would do in that situation. My midwife did say about arranging another app with consultant so maybe that would help.

Talking of hospital bag, I bought everything I need a few weeks ago during a clm moment to get it over and done with! As I really won't be able to think about it near the time!