PTSD/PND/OCD/tokophobia - birth planning help re natural/induction/elcs

[thunksheadontable]

Hi,

I've posted on the Childbirth thread but would like thoughts from here too if you don't mind!

I am 32 weeks pregnant and have a diagnosis of OCD, with maybe some PTSD as well. It's fairly clear now I also had PND after ds (2) though I didn't really realise this at the time.

My birth was not overly traumatic until the very end (like so many first-timers!) and I think the PTSD is less because it was terribly traumatic (though it was a Kielland's forceps and I had a LONG slow recovery after it) than the feeling of loss of control which triggered all sort of other issues from my past. I don't remember anything of the first 72 hours of my son's life though apparently I was acting normally and I even wrote an account of the birth the next day, which I have only been able to bring myself to look at in therapy this week.

I am starting sertraline, am under the care of a consultant Perinatal psychiatrist, seeing a pregnancy suppport midwife, doing private CBT, mindfulness compassion therapy and also trying hypnobirthing.. but I am having a shit time of it, crying all week on and off or swinging between massive anxiety and severe irritability and exhaustion/confusion and just really scared of the sertraline even though I want this to dampen down..

Anyway, the CBT lady thinks I might do best to ask for an elective section.. she feels I am working myself into a frenzy trying to "cure" my fear of birth in too short a time frame.. but consultant and supervisor of midwives at hospital terrified me about cs too.. I just feel trapped and terrified and going round in circles with no way out.

Any thoughts? I know really I need to work out what to do.. but I don't know if I am strong enough right now. Everyone in RL just keeps saying "oh it will be fine, this is just birth, it will be fine". Slightly misses the point about being mentally unwell! Feels like the birth equivalent of "why don't you just pull yourself together?" or "hey, the glass is half full you know!"

Thanks in advance, sorry so long!

OK apart from the what is good/right/proper/waht you should do and feel you should do....what do you want, deep in your heart of hearts.

I have no idea! Honestly. I can see pros and cons to every possible option even on my least anxious day. I have a major problem with working out what I want at the best of times, I tend to rely on external evidence. So I guess that's the problem!

I'd like the certainty of the section datewise but am afraid of the pain. I'd like the semi-certainty of an induction at term or just generally anything that would prevent me going overdue because that's when I'll start to flip out for real I think. I'd love a beautiful waterbirth in the hospital that was calm and quick but I know no one can guarantee me I'll even get a pool. I don't think a homebirth is for me.

Realistically, right, what I would like is to know for certain they won't turn me away from the hospital (my unit seems to close a few times a month due to understaffing), doubt me if I am in pain or deny me an epidural if it all becomes too much, and that I wouldn't be left alone for great long periods of time in agony because they wanted to stall on the epidural. I'd like to have a midwife more or less bobbing around who could reassure me (can't afford a doula) and I'd like them to explain what the hell is going on to me instead of talking to eachother or darkly muttering "suspicious", "suspicious". I'd like not to have people bantering while they do vaginal exams and calling in 2 or 3 people to do it while making jokes about my fanjo and I'd like them to be aware of and respectful of the fact that I have OCD and that I may be a bit stressy (e.g. I don't want anyone rolling their eyes or being terse with me if I don't cope well with a level of pain they think is reasonable).

So sort of like a NICE guideline birth with access to an epidural if and when I need one without being fobbed off or discouraged, some dignity and a bit of awareness and compassion for the hell that has been this nine months of pregnancy.

Yet that seems like too much to ask and impossible to guarantee, so whatever will be the most protective of my mental well-being so that I can be there for my baby and my toddler and come back to my family sooner rather than later instead of living in this bloody misery.

It sounds like an epidural may be your best friend. In the circumstances it would seem reasonable to me to discuss beforehand your need for an early epidural, control over when and how often you have examinations as well.

As long as you are aware that epidurals can sometimes slow things down a little and it is difficult to stay upright and active. Ah more pros and cons, just what you need.

But I would not think that an early epidural is too much to ask.

It's a hard one as there are so many things to consider.

I'm inclined to agree with your CBT lady and think that an ELCS is probably the way to go. In my view this gives you more control. The downside is of course the longer recovery time after birth.

The reason I think this may be best is when giving birth naturally there are so many variables. I've given birth four times and each one has been different. I was induced with my first and had an epidural (which was lovely), but the labour was long and due to the induction and epidural, more medical intervention was required. Frequent monitoring and examinations and yes you are confined to the bed this way.

Second time around I went into labour naturally and spent a little while in the birthing pool which was great. However my contractions slowed down, I was eventually put on a drip to speed them up and my DD got stuck and had to be helped out by ventouse.

My last two births were slightly more straightforward but what concerned me each time was how quickly things can change or go wrong if you like. You need to be able to adapt. My view is that it is harder to have control if it is important to you that you are able to do so.

i have OCD and have admitted this in 3 of my 4 labours..1 was natural,1 emergency c sect,other elective so i have experience of all 3!

i had nothing but wonderful midwives who asked questions r.e how best support me with OCD and made me feel comfortable at a timewe are very vulnerable

as for whats best only you can decide.i found the control of elective was strangely relaxing but the recovery is long and if you like be up and doing this is not for you..i fought to keep going and made PND worse.as for the pain afterwards you are given morphine anad again before move up onto a ward.painkillers are on offer so dont be afraid to ask for them

if you think you could handle the epidural id probably go with that tbh.it will ease your anxiety with pain and allow you the natural birth you seem to be asking for

be honest with staff about how you feel and what you need from them.it was a bit embarrassing for me the first time but they were so lovely about it and with the other 2 i had no qualms saying what i wanted

i so hope you can have such a positive experiance as i did.good luck.x

Thanks for feedback, everyone.

Madmouse, instinctively I feel that knowing there is access to an epidural is what I need. Yet there is such negativity about guaranteeing it, which I find a bit barbaric given that there's no other circumstances where people would be denied pain relief if they suddenly direly needed it. I know all the potential downsides to it and I would love a natural birth if I thought I was mentally up to it, but I am not sure I am willing to test it.

Orangeflutie, it is the uncertainty that kills me. I found how rapidly it changed very terrifying. Most of my labour and delivery was really calm, nice, lovely. It was the last bit where I just sort of lost it and where I felt terrified and trapped and pinned down. The delivery itself was quite traumatic in a physical sense, they really had to yank him out of there.. and though I know now that the danger to us both was minimal, it certainly didn't feel that way at the time. I felt so totally powerless and I recognise from herapy that a) I have a heightened threat response and often have a disproportionate reaction to things that seem threatening even if they are, in fact, not and b) I have a deep distrust of handing over my wellbeing to other people, which makes loss of control hard. I know this now but my heart lags behind my head.

I just don't want to choose an elcs in a way that lets the OCD "win" if you will. I recognise that a lot of my OCD behaviour in relation to this pregnancy is about reassurance seeking and control, control, control.. and would anything change that.. will anything I arrange stop the fear if it is just a feature of my OCD? am I buying myself 6 weeks of painful recovery to avoid an unlikely scenario because this imp in my brain is convincing myself this additional medical intervention is necessary or am I being reasonable? I don't know, to be truthful.

Liveinazoo, did you write a specific birth plan? I did one with the supervisor of midwives and it mentions at the top I have OCD and had a prolonged anxiety state after my last birth but other than that she said I didn't need any details as it wasn't "appropriate". I kind of felt a bit peeved by this, because I feel enough shame about this bloody thing without a professional suggesting that it's "not something it would be appropriate for others to know" as if it really were shameful. My rational mind knows it's not, it's an ilness.. and would there be that reaction if it were a physical illness? What sort of info did you give them/what did you ask them to do? I need to work out what I really need from midwives vs what the OCD tells me I need, if that makes sense. This is a big feature of how I feel right now.. what is me, what is OCD?

Thanks for all your time and input.

From my experience there are two things that can come between you and an epidural: you being too close to giving birth (ie half an hour away from pushing) and the anaesthesist being tied up elsewhere which can cause a delay. Other than that, if you are in pain and really want an epidural there's no reason to refuse one.

hi - I have mental health issues, so the people involved in my care had a joint meeting about me before my EDD and devised a plan to help me. This meeting involved the psychiatrist, mental health midwife, my own midwife, someone from labour ward etc. They then decided what was best for my induction (needed an induction due to physical reason) - which meant instead of being in a bay with 3 others being induced I got my own room on labour ward, 1:1 midwife care in labour (I was there for days so staff loved being my worker as they got very easy shifts!!), senior midwives in charge of me or those with mental health links and also a tour of the labour ward with the mental health midwife before hand and a chance to talk issue through regarding the birth. I ended up with an emergency c-section, but because each shift the anaesethetist involved introduced themselves, the dr's did, the senior midwife did it was very calm for me. My plan involved daily midwife visits if needed, early checking for PND etc.

Don't know if any use to you, but the meeting was helpful for the professionals and the information was shared with each shift change in my labour. I was able to give them my birth plan (you could write yours in advance to say if you want an epidural etc) in advance so they knew what it was and reasons for it (some medical). I wasn't at the meeting, nor suggested it but the care resulting from it was very reassurring.

Hope all goes well for you. x

OCD and anxiety/depression were out on my notes
i had own room with ensuite
try in a logical moment think what youd like ideally and work from there

the midwives that looked after me asked how ocd affected me and i told them and we worked out what i neede from there

i also had a midwife with me at all times from admission so was never "alone and helpless feeling"-that helped me a lot