Fear - Hypnobirthing, therapy or private midwife

[XjustagirlX]

For someone who is terrified of childbirth and pain, which option is best? Hypnobirthing, talking to a therapist or hiring a private midwife.

fears are:

• the pain of contractions and birth with a low pain threshold.
• fear of medical environments and the medical team not respecting my wishes. Specifically no one shoving their fingers inside me e.g membrane sweeps, vaginal exams
• not getting the pain relief I want due to refusing vaginal exams etc.

I can’t afford all three so I’m trying to decide where best to spend my money.

I will be doing the positive birth company Hypnobirthing online courses.

What pain relief do you think you will want?

@MissScarletInTheBallroom I’ve never experienced vaginal labour before so I have no idea what i can tolerate.

I feel like I will want gas and air, tens machine, remifentynal (sp?) and considering epidural.

Based on what you’ve said I would say try therapy first, or hypnobirthing. I did a hypnobirthing course when pregnant (daughter is now 9 months old) and I do think it was beneficial for me as I understood more really from that about the stages of labour, breathing techniques and how they actually work to help you.

Therapy I think would probably help with some of your other concerns because one thing to consider is that if you plan to refuse all checks then you will be limited in terms of pain relief as there are certain ones you can only have once at a certain stage of labour (like an epidural). Therapy will help with the medical fear & the fear of the unknown, speak to your midwife about your concerns and get the information on what the checks are for/why they do them.

I live in a country where about 90% of women have an epidural and other forms of pain relief aren't really available because they consider that the epidural is the only form of pain relief that actually works. Because of that, no woman has to fight for an epidural (it's actually more difficult to refuse one), and so she can pretty much guarantee that unless she's literally about to start pushing, if she asks for an epidural she will get one pronto.

I've never given birth in the UK but I've heard many stories of NHS midwives trying to discourage labouring women from having an epidural, telling her she doesn't need one and just needs to woman up a bit, telling her it's too early or too late, telling her it will increase the risk of complications (it won't).

In my opinion, if you think you would like an epidural you should talk to your midwife at an early stage, say you're very afraid of labour pain, and you want your birth plan to based on having an early epidural. You can always decide you don't want it, or don't want it yet, once you're in labour. If you get pushback, you could even start talking about having an elective C-section in that case, because you're really afraid of the labour pain. If they are ideologically opposed to epidurals they will probably also be ideologically opposed to elective C-sections on maternal request, and probably think the epidural is the lesser of two evils.

The point is, have a birth plan which is clearly centred around receiving effective pain relief when you request it (and not three hours later).

In my opinion you get the most benefit from an epidural when you have it once you're in active labour, and when you probably have enough hours of active labour ahead of you to fully benefit from the pain relief. Women who have bad experiences with epidurals are usually the ones who get them at a late stage, having suffered through hours of long and painful labour beforehand, and who are already scared and stressed and tired. Whereas women who get one nice and early before the contractions have become too painful quite often have nice stories of lying down for a nap, or watching box sets until it was time to push.

A private midwife will aim to get to know you and your partner, and your specific fears and worries very well before you go into labour. By the time labour happens you'll have had lots of conversations (and cups of tea!), you'll have gone through all your options and choices and likely labour scenarios together, you'll have made some specific and individualised plans, and she'll really be able to be your right hand woman and advocate for what you need/ want in labour. She'll be with you from labour at home (if you want), through the journey to hospital, the labour and birth I hospital and for some hours after the birth, as well as being able to see you and baby very regularly once you're home - great for both your recovery, and for debriefing with someone who was actually there with you.

A good private midwife will have links to the hospital you're planning to birth in and will smooth the path of your stay there as much as possible, she will know the short-cuts and who to speak to to get you what you want/ need.

It may be worth asking to speak to an anaesthetist in pregnancy (before labour) to find out what analgesia is available at your unit (is remi definitely an option where you are?..it isn't everywhere yet) and to go through the pros and cons of epidurals in more detail to help inform your decision. Also perhaps worth looking at if you've not seen it already is the labourpains.org website which has a lot of information about the various pain relief options as well as anaesthetics for delivery. HTH.

I don’t see them having any issue giving you gas and air at any time in the labour.

Tens machine will be your own personal device to use so you can use that at home and come into hospital using it when contractions are happening.

I don’t think they can give you an epidural without establishing how dilated you are with a vaginal examination. So unless others arrive to correct me, I think that wi be your barrier to epidural. They need to be sure before that happens - they aren’t just given out on a whim.

Sometimes you can insist you are really far along (I thought I was with dc1 but I was between 3-4cm!! DC2 I was 9cm and still surviving on just gas and air). Midwives will know how close you are to meeting baby (and how much pain relief is right for you) than you will.

Kindly you haven’t given birth in the uk so quite a lot of your advice won’t be correct for this country.

Hopsifals here aren’t ideologically opposed to epidurals, they just have procedures to follow before they are signed off. Anaesthetists aren’t always available on demand as they could be needed elsewhere for a higher priority case. So you can’t just put it in your birth plan and demand when it happens. Birth plans are preferences not your right.
Midwives specifically cannot guarantee you an epidural in advance as it’s on a case by case basis as to if and when the anaesthetist can see you.

If OP wants to guarantee either an epidural or elective c section, she’s actually more likely to get the elective c section as it’s now NHS policy you can be guaranteed one at maternal request purely on preference and not medically necessary.

I think it depends on your reasons for your fear. If you have trauma that would mean you are more triggered by hospital environments / vaginal exams this absolutely would benefit being discussed with a therapist and if you were pregnant bringing it up with your midwife so you can be cared for in the correct way.

If it is not trauma related and just fear of pain (and I don’t mean that in a condescending way because I was exactly the same!) I could really recommend hypnobirthing. I would also consider looking into a doula. I had both for my DC1 and I can say hand on heart that that combination made a huge difference.

I wouldn’t really recommend a private midwife. I had one for DC2 and it was a total waste of money and they can’t come to a hospital in a medical capacity once you’re in labour, just a birth partner. It’s only really worth it if you 100% want a home birth and even then, most trusts have fantastic home birth teams anyway. My private midwife (who was from a very reputable company) ended up flaking on me at the last minute and I ended up getting a full refund. It just felt utterly pointless!

To answer the below:

• fear of medical environments and the medical team not respecting my wishes. Specifically no one shoving their fingers inside me e.g membrane sweeps, vaginal exams You absolutely do not need to accept or consent to vaginal exams. Discuss it with your midwife in advance and have it clearly on your notes. No means no. The ball is in your court with this and they cannot force you to have an exam without your consent.

• not getting the pain relief I want due to refusing vaginal exams etc. this should not happen. Discuss with your midwife and ask the implications of refusing exams and if this would affect your ability to have the pain relief you require. It would be very surprised if this was an issue.

Hypnobirthing. In person if possible.

Just so you know, I felt the way you did. A splinter or knocked elbow and I'm screaming and crying. Tiny pain threshold. I was a bloody Goddess in labour. It totally empowered me and DH was wildly impressed. You are creating a life, that was above all the pain for me.

Hypnobirthing (informal - one session!) helped me go into myself for the strength and work through my fears.

It's worth it.

gas and air isn't universally available any more - it's slowly disappearing from medicine for a combination of medical (chronic exposure to staff rather than short term exposure to patients) and environmental reasons. The OP would need to check they still have it as an option (most places do still have it to be fair, but just not everywhere).

from a purely anaesthetic PoV, you don't absolutely have to know how dilated someone is before siting an epidural, but there needs to be regular contractions suggesting 'proper labour', no major concerns and an 'end in sight'. There can be some definite advantages to knowing beforehand though as the risks/benefits are slightly different very early on and very late on and that may affect whether a woman wants to proceed. There is no guarantee that an epidural will actually work of course (1:8 are inadequate to be the sole means of analgesia in labour) and how a poorly working epidural is best managed may depend on how far along/smoothly things are going.

I don't mean this in any condescending way whatsoever, only sharing my own experience.

DC1 born in covid. I had no pain relief (not by choice but lack of medical staff to triage me) until 8cm dilated. Ended up giving birth with just gas&air in the very last stages of labour.

DC2 I got cocky and thought I bossed #1 so #2 will be a walk in the park. It was a much longer labour and therefore felt more painful but not because of the actual pain, just because of being fed up it went on for so long.

Either way with both there was a point in which the pain turned in so some kind of adrenaline and the pain just felt like a blur. I really can't explain it more than your body just does what it needs to and although yes it hurts, you kind of just do it and (for me personally) you ignore the pain. Really don't know how else to describe it.

I do believe it's all about how you explain that to yourself in the moment so based on that I do think you should speak to a therapist and unlock maybe why you're having such strong feelings towards all the examinations (I didn't want sweeps but ended up just saying yes because I was so tired I needed baby out. They ask permission before they do anything at all) and then hypnobirthing to work out how you deal with the labour when it comes

This was me. I was so afraid of birth with my DD. I did hypnobirthing and listened to any birth positive podcast I could get my hands on (Happy Mum Happy Baby on Spotify was fab). I was adamant I wanted an epidural at the first sign of a contraction. I made sure everyone was aware that an epidural was my wish.
However, when I went into labour, I was fortunate to have a quick labour and to my initial horror, I was unable to have an epidural as I was surprisingly fully dialated on arrival at the hospital and ready to push! My midwife was so encouraging. I had the pain relief injection (in my arm or leg- it's a blur) and gas and air. The gas and air was simply amazing and way more effective than I had imagined. I also had down there numbed around the entrance in case of an episiotomy (which I didn't need in the end) which I think helped a lot.
The lack of epidural meant that I could go home a few hours later. I know I was so lucky with the birth and everybody's situation is so different, but your body can so do this and positive mindset goes a long, long way. I was terrified but I regret spending the last couple weeks of pregnancy worrying. Talk to your midwife too. You can absolutely do this

Read the book "A better birth by soibian miller " it's brilliant and changed my mindset on birth.
I just gave birth to my little girl (second) and had an awful first birth. Even though this one was induced , it was much better than my first and I felt so empowered.
Child birth is painful but your body just takes over and does it.
You will smash it 🙏

I vote hypnobirthing, especially if you can do an in person course. All I could access was the books but they were great.

I had a private midwife who offered hypnobirthing. Managed to have 2 at home with no pain relief but I don't think that's what you're aiming for! At the time she was uninsured and unable to work in hospitals but I think the situation has changed. If you're based in N London I know a fantastic doula who I am certain can help you with the fear if she's not already retired

Elective C section

Hypnobirthing! :)

https://pubmed.ncbi.nlm.nih.gov/35083920/

Another recommendation for hypnobirting and reading "A better birth by soibian miller "

I was terrified of birth and asked for an ECC in my booking appointment which was booked in but after reading books, doing free classes, watching positive birth videos, it massively shifted my mindset. Also talk to your midwife they can refer you to someone who deals with birth options so you can discuss your fears and they can help with best options :)

My home birth midwives were the absolute best medical professionals I've encountered when it comes to informed consent. The two home births I had I didn't have any VEs, they weren't particularly interested in doing them.

I’m not sure if you have had your baby but I just wanted to add that every woman experiences contractions differently but having recently given birth, following a long and very intensive labour, I would strongly recommend an epidural based on what you have said. Gas and air made me feel sick, I declined pethadine so can’t comment on that, and my partner couldn’t get our tens machine to work! It had been lent by a friend and we stupidly didn’t check it over in advance. All I managed with was a comb until I was 8cm dilated.

Epidural was the only pain relief that worked and it didn’t hurt at all when it was administered - i got used to needles during pregnancy from all the blood tests.

I actually did find labour really hard, i wasn’t one of the women who had a positive experience not because of the hospital just because of my contractions were more intense than I was expecting and I had a forceps delivery. I was very glad for the epidural, which was only administered right at the end but was a godsend when it came. I was able to nap right up until “pushing”!

As others have said it’s not something that can be guaranteed but definitely stay open to it.

Wishing you all the best ❤️

This is so true - labour / birth pain is natural, it is so empowering!

I did the PBC online course and this really assisted in understanding your body.