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Tuesday
Nov202007

A General Anesthetic Story (for Tokophobics)

I stumbled upon this story just now - Under the Knife and Feeling It All - and while it is rare, it isn't as rare as having a baby die during a uterine rupture during a VBAC!

1 in 1000 general anesthesia cases are aware of some or all of their surgeries. It isn't always pain, but awareness has to be horrifying all on its own! Listening to the party atmosphere often found in operating rooms would be horrid if I were under anesthesia for cancer or some other equally serious reason. ("Is anyone paying attention to me? Does anyone even see I am awake?")

100 of those 1000 feel every part of the surgery, from incisions to removal of body parts to sewing the body back together, layer by layer.

I cannot even imagine.

Wednesday
Oct312007

Helen Mirren & Tokophobia

Helen Mirren, in an article for the Daily Mail, talked about her disgust for childbirth and how watching a birth movie as a teen swore her off having kids for life. Here is the entire article. Below are the excerpts that pertain to the birth movie:

"And they sat us all down, boys and girls, all about 13, 14 years old in this horrible school hall.

"And then this tweed-skirted dykey sort of woman, short cropped hair, comes on and says, 'I'm Dr Joyce' or whatever, 'and what you're about to see is one of the greatest miracles.

"I've seen it many times you know because I'm a doctor and giving birth is one of the most beautiful things'."

Dame Helen recalls how the group were wondering what she was talking about and then the film began.

To this day she can remember it - the whirring of the projector and a close-up of a woman having a baby.

"And that's all you see and these are 13-year-old boys and girls who can't look at each other anyway, and it's bloody and it's disgusting.

"And then occasionally a little subtitle comes up because there's no soundtrack. It says, 'Now prepare the rubber sheet'."

She said she had put her hands up to her face, realising she could not watch it.

Within 30 seconds two boys had fainted and were carried out while the 'stupid woman' said: "Wasn't that wonderful? It's a miracle."

Dame Helen said: "I swear it traumatised me to this day. I haven't had children and now I can't look at anything to do with childbirth. It absolutely disgusts me."

Her early sexual experiences were no better. "They were crap because the men were crap. They were just nasty boys."

The interviewer asked: "And you truly think that film is the reason you didn't have kids?"

Dame Helen replied: "I think it's a lot to do with it, I think in deep proper psychological terms I was traumatised."

Those of us who live and breathe birth might be thinking thoughts like, “How horrid!” “What a disservice to women and birth!” “She sure doesn’t know what she missed.” Or “How sad.”

But, I want to share that another one of my posts, a very old one, would have those commenters saying, “Thank God! Someone famous that feels like me!” “I can’t believe someone else said what I think in a public forum.” “She feels exactly like I do!” And “I’m not alone.”

My post on Tokophobia (fear of childbirth) continues receiving comments and I have been meaning to re-write a new piece for quite some time, answering the women who have written. The truth is, I’m not sure how to answer some of them. I can’t cure their fears - can’t wave a magic wand and tell them it will all be okay. I can’t promise a perfect birth, a painless, (vagina) tear-less, hemorrhoid-less, incontinent-free birth. None of us can. The difference between those of us steeped in BirthLand and those living in Tokophobia World is the former kinda care (or don’t care) about the inconveniences that might happen to get a baby and the latter are terrified/horrified/grossed out by the same things.

Read here, some of the comments women have written me regarding their tokophobic feelings:

- So glad someone has addressed this. I realize that I am not alone in my disgust and dread of childbirth. What's weird is that I love babies and children but am paralyzed with fear when considering having a child of my own naturally. Even stranger, I am a registered nurse. I've cared for burn patients, people with their faces blown off, and people half-eaten by flesh-eating bacteria. These patients have never inspired the anxiety that I feel when I've assisted with natural childbirth. The screaming, defecation tissue tearing, placenta, and gore is nothing less than gruesome to me. I'm puzzled by other nurses' remarks of the "beautiful experience" that childbirth is when I've helped these exhausted women care for their ravaged bodies and squalling infants. I am struck by how primitive, undignified, and unevolved the experience is and have wondered how any woman goes through the experience more than once without demanding a c-section the next time around. Time is running out for me as I'm in my early 30s now. My husband has been hinting for a while that he wants to start soon. The panic has set in at times and the worry that I'll never have enough chutzpah weighs relentlessly on my mind.

- I left the love of my life rather than have a child for him--he never knew that was the reason--and I have spent a lifetime telling people I don't like children just to get them off my back. If my family knew I was tokophobic I would be run out of town on the rails--it would never have been tolerated. But there has never been anything about birth that doesn't either gross me out to the max or appear to be really horrendous for the body. I would never put myself through childbirth willingly. Gross! So, even though I always wanted a child, and a husband, and a home, etc., I found a way to hide the tokophobia and it changed my life. No amount of reading a natural birth board is going to cure tokophobia. There might be some sort of treatment for it, but women with tokophobia would be better served to be accepted as they are. There are tons of us out here, believe me.

- Phew, I am so relieved to find that i'm not the only one. I am so fed up with people saying 'its ok and its not as bad as you think'. They don’t have the same feelings as I do. I sweat and feel faint when I think of giving birth and I am avoiding it at every cost. I have felt like this since I was a child. I hate the way in which 'society' makes women feel that they must have a baby....and I too do not want to grow old and be left childless....but I just cannot bring myself to do it...it never feels right. My biggest fear is being ripped open (my hands have just gone soaking wet saying this). For years I have had problems having sex, I bleed, tear and tense up...it’s a whole horrid package. I wish either way I could just make a decision to either never have kids or to just get it out the way and do it. What on earth can I do?

- But the thought of being in tremendous pain for hours and hours and then feeling my vagina rip open. [I mean imagine horror movies when people are stabbed. I mean oh my goodness! It's like the same thing because it's skin being torn apart in some way and it's no small paper cut] And then I have white coat syndrome but if I have a homebirth I can't have an epidural. Oh dear lord Jesus it scares me to death. and then like I don't want people touching and looking at my vagina, which is already ugly and will look even more ugly as a baby human being slowly pulls it apart. And labor seems so scary. Though I love children all the time, I hate children when this thought comes about. I feel like no one cares about me, the one who is pain, worry, and terrified. Everyone just thinks of this stupid baby that doesn't care anything about what’s going on because it doesn't know anything.

And yes tokophobia is real. I have had this fear since I was about 3 years old, before I even knew that "phobia" itself was a word. But I also have a panic/anxiety disorder and that may be the base of it. But the fear I feel is real.

- Me too. I asked for a caesarean section to avoid a vaginal birth. I was abused as a child. I am a midwife and I know about birth - the wonderful peaceful ones, the empowering ones, the awful disempowering medicalised ones. I know that the hormones which I would have released in labour - those of fear and terror - would have stopped the oxytocin, stopped the labour and forced me to endure what I feared the most. I dreamed of faceless masked men examining me and cutting me and not stopping when i asked them to. I punched my swollen belly and cried at being taken over by this alien invader. I knew I was going to find it tough enough becoming a mother without haveing to endure a traumatic birth and the subsequent flashbacks. I was lucky. I had a very sympathetic consultant and a caesarean on request. My birth was controlled, quiet, non sexual and I am a proud mummy who loves my son. Thank God - it could have been so different.

- I am now hopefully a bit too old to get easily pregnant and what a relief it is. As far as I can remember, I found childbirth scary and disgusting. Even humiliating. I have read that it can be cured sometimes with counselling but my condition is gone so far that I don’t have the desire to be cured at all. I feel that my fear and my disgust are normal.

- I am so thankful for this post. This needs to be discussed more openly and honestly. So many women feel this way, but we think that something is terribly wrong with us, and we are ashamed. I have always been intensely afraid of pregnancy and childbirth. I remember when I was a very little girl, I was completely disgusted at the idea of having a child, and I wanted to adopt. I am now 23 and my feelings haven't changed. Why does this happen to us? Does therapy work? I am married now, and my husband doesn't understand my fear at all. I feel alone and frightened. Please continue to write on this, and point us in any direction that might be helpful.

- I have Tokophobia. I am also 23 weeks pregnant with my second child, I cry every night and feel physically sick at the thought of premature labour and delivery. I also have a sympathetic consultant who will give me a c/section under a GA (general anesthesia) as I had on request with my first son. I am 36, a registered nurse, have a masters in Psychology and am NEVER going to give birth the so called natural way. I am tired of being told I am a failure as a 'woman' or will not bond with my child. I have the rest of its life to bond with my child! Thank you for making me feel that my phobia is actually out there - I am not alone!

- i feel like im letting my partner down, he wants kids now and doesn't really believe me when I say im scared, everyone thinks im joking. im scared of the pain, being laughed at, being useless, a wimp, and as someone else mentioned being ripped open and having to be cut, midwives and doctors frighten me i think they wouldn’t really care about what i had to say and would make me feel small.

A midwife told my friend off once for being too loud when she was giving birth.

i love kids and so desperately want to be a mum, the in-laws and my own parents cant wait to be grand-parents but ive already decided that I CANT and will not ever give birth (deliver). I wish i was a man and had a lovely wife that was willing to give birth happily so i could have my own children.

I just feel a failure and weak.

- There's been quite a few problems in my life caused by tokophobia. I left the love of my life over it because he wanted kids and there was no way I could ever do it. I have found childbirth absolutely repulsive my entire life. It really, really makes my skin crawl. I have had to pretend that I would be afraid I would abuse a child (I have a bit of a hot temper) just so I have an excuse not to have children. I can't tell you the number of times I left a good relationship because the guy wanted to have kids. The only reason I finally found a sorta-ok relationship is that I am now over 45 and he doesn't realize I could still get pregnant. He would want me to have a kid if he thought I could still do it. (I'm convinced I could still get pregnant, my fertility happens to be legendary, what a nasty trick of nature!) Tokophobia has created huge problems with my family, too. They were very irritated that I never had a child. I just can't do it. And the sad part is that I so wanted to have a baby. I didn't want to not have a baby. It was just the terror of pregnancy and childbirth, and no amount of counseling was going to change it. So now, I am too old, and when my mother dies I am going to be in this just-ok relationship or alone. Just a cousin in another state, no other relatives. It's a nasty phobia and it has shaped my life so very negatively.

- I am 27 and nearly 5 months pregnant. I only realised my tokophobia (or at least it only developed) after I found out I was pregnant with our planned baby. I had a placenta previa - a blocked cervix so the baby could only be delivered by c section. I was thrilled that I had been given a way out...as I am only really terrified of the birth not the pregnancy. It’s the thought of tearing that just makes me burst into tears ...

However placenta previa have a tendency to move and guess what!? Mine has...

so now I am being refused a c section and told to do it naturally and it is natural to be scared! SCARED! I am not scared! I am blood curdlingly terrified! I have been having a really happy pregnancy but now feel that if I have this baby naturally I will hate it. This news has now made me resent having this baby and I just can't get anyone to take me seriously...

even though the doctors have been playing games with me and building me up and now letting me down.

So I am extremely grateful to hear of others shared fears. My husband keeps saying well I will be with you...but that is no help. What the hell is he gonna do? And I am terrified of being ruined afterwards and sex being pointless and unenjoyable for both of us, but especially him. I am scared of all the aftermath too. The incontinence, possible permanent internal damage...! How can I be expected to go through that! And drugs are not the answer ...not to my real fears. Funnily if it was just the pain I would not care!It feels like I have been given so many months to live but have to face execution at the end. I know it sounds severe but a c section was like an open door at the end of all this and now the jail gates are shut.

- I can't believe how much better I feel to read that I am not alone. I am having a very difficult time facing the idea of childbirth...actually, pregnancy too. I am almost 33 years old and married to a wonderful man who wants children. When we married 2 years ago, I told him I also wanted children. And I do, I just don't want to give birth. I mentioned adoption and he won't even listen to me about it. He says he just can't get excited about adoptin. Here's my problem: I don't want a baby wriggling around inside me, I don't want to give birth and squeeze a human being out of my body *cringe*, and most of all, I don't want it trying to cling to my breast. I always thought of myself as a warm, loving and bubbly person. So why do I feel cold, like I'm Cruella DaVille or something? If I don't have a baby, it's just me, the hubby, a dog and no real family (no siblings, parents are deceased). That's no life either. So I guess I gotta pick my poison, huh?

- I don’t fear pregnancy much although I hope I don’t get morning sickness, hemorrhoids, droopy and flat boobs (I have small breasts) or varicose veins. I do totally understand the fear of tearing, of not looking or feeling the same sexually to myself or a partner, of incontinence. I was raised to think of my body as a sexual thing (tho not explicitly most of the time) so the idea of birth as a sexual event and babies attached to the actual breast seem gross, almost incestual. Even tho I know that biologically they have a dual purpose, I just seems wrong somehow. Maybe too much emphasis was placed on sexuality? I figure maybe I can navigate some of it by waterbirth. Keep the lights low and my partner can’t see the baby emerge. The buoyancy of the water is also supposed to help alleviate pressure and reduce the likelihood of tearing (I hope this helps those of you with that specific fear!) I find myself most confused by the simultaneous fear of birth, yet the curiosity to experience it. As for it being a miracle, the baby is great. I'd love empowerment, but I'm afraid all I'll get is an anxiety attack during labor from pain and fear of judgment for that pain or for making noise or whatever. In some ways, I think I'd rather labor alone than have a partner with me. I'm not sure I want him to see me so exposed, emotionally and physically. I heard of one woman who had her husband catch the baby and said how special it was to have *rough quote* "the baby was touched on the outside for the first time by the man who created it with love"-it sounds nice, but I can't for the life of me understand women who want their husbands to catch the baby. I don’t want him down there. They are fleeting and I know they are irrational, but I also sometimes hope for there to be a need for a c-section, even tho recovery is physically more difficult. I fear that I will have flashbacks or phantom labor pain, like soldiers do who lose limbs. I worry that I won't be able to look at the world the same way afterward or that my partner will no longer desire me or will love the baby more. I have seen women write that they love the kids more than their husbands. I understand loving them differently, but one more than the other is sick. Why did they get married, just to have babies? It makes me worry that I will resent my kids.

- Sometimes I think I am the only rational woman in the world - why wouldn't such a disgusting, terrifying, bloody, screaming process inspire fear and avoidance? I sweat and feel faint at the thought; I freak out even just trying to talk about it with my husband or therapist.Someone else already wrote: "being in tremendous pain for hours and hours and then feeling my vagina rip open. [I mean imagine horror movies when people are stabbed. I mean oh my goodness! It's like the same thing because its skin being torn apart in some way and it's no small paper cut] and then I have white coat syndrome but if I have a homebirth I can't have an epidural. Oh dear lord Jesus it scares me to death. and then like i don't want people touching and looking at my vagina, which is already ugly and will look even more ugly as a baby human being slowly pulls it apart. And labor seems so scary. Though I love children all the time, I hate children when this thought comes about. I feel like no one cares about me, the one who is pain , worry , and terrified. Everyone just thinks of this stupid baby that doesn't care anything about what’s going on because it doesn't know anything." This is EXACTLY how I feel. What are we going to do? I am so depressed at the thought of never being able to have children; but even more depressed and fearful of having to dread this for 9 months, then actually go through this, and then live with the memories of it. I feel as though i owe it to my husband to leave him so he can find someone willing to do this for him.

- I am too old to have a child now--over 45, and in perimenopause and single as well--but just yesterday my 80 year old mother threw a fit because I never managed to have a child and she now has no grandchildren. I have several friends with the same phobia--several had terminations rather than deal with childbirth. This is a massive problem that's been under the carpet for too long. We need to get back to the point where women have more options in childbirth, including general anesthesia and no memory of the birth experience.
A very wealthy friend of mine, who could afford in-home care for the child, arranged to have her baby that way, and she was thrilled with it. No memory of it at all. No labor, no nothing. Just woke up to excellent nursing care in the hospital, care for her and the baby at home, no breastfeeding, no shredded crotch, no lochia, nothing. Very peaceful, no dramatics, no crises, adequate pain meds for the recovery, no labor pain at all. If I could have had a birth like that--essentially not being conscious of it but still getting the baby as a result--I could have given my mother a grandchild and I wouldn't be completely alone when she dies. But no, childbirth is the only medical procedure (and it frequently deteriorates to that, no matter what the crunchies say) where you have to suffer endless torture that wouldn't even be legal at Guantanamo Bay, and be conscious of it to boot. I deserve better than that, and all women deserve better than that. We need more options and less sass from the natural childbirth crowd.

The last commentator sent me to this recently written article about tokophobia "Are you a tokophobic? The women who are terrified to give birth". A portion says:

“’I strongly feel that the only way I'd be able to do that, if at all, would be to have a Caesarean - which would be less gory because I could be sedated - and probably some therapy during pregnancy, because I find the thought of having my stomach cut open pretty horrifying.

‘The truth is that the very thought of having something almost alien-like growing inside me is disgusting.’

Of course, for most women, the anticipation of labour comes with a degree of anxiety. But as many as one in seven women are thought to suffer from tokophobia (a word which derives from the Greek ‘tokos’ meaning childbirth).

Dealing with the condition is often difficult because it remains one of society's taboo subjects.

Despite her desire to find a way to have children, Rachel has been labelled ‘cold-hearted’ and a ‘babyhater’ by some friends she has discussed her fears with.”

The article goes on to say how misunderstood tokophobes are, how natural birthing women can go to extremes in not accepting how horrified some women are at the seemingly typical experiences of pregnancy, labor and birth.

In reading the comments all these months and in writing this, my heart breaks for most of the women because they haven’t been able to resolve their dilemmas. I’ve wanted to wrap my arms around them to make it all better, but know I can’t… nothing I do or say will make it miraculously better. But, I think together, all of us might be able to do something. What can we do? What can we say? I hope you all will comment. I hope you will work hard not to say trite comments that say things like, “It’ll be fine. Just do it!” because you won’t be there with them as they work through 9 months of terror. I’m hoping that others will have insightful things to share that will be understanding and as accepting as possible given the really foreign topic we are discussing.

Let’s see what I would say if any of them were sitting with me as pre-conception counseling clients.

- I remember how terrified I was when I was pregnant the first time… even the second time! I felt faint thinking of what labor was going to feel like. I kept imagining this unbearable, other-worldly alien-being taking over my body and causing me such agony I would surely die from the pain. And I was a baby! I screamed for hours when I stepped on a dead bee once. My family laughed at me for years about that, reminding me, over and over, that I would never cut it as a natural birth candidate once I got pregnant. I remember crying for hours, worried about labor and birth. Even the second time, I remember being scared and, once labor kicked in, thinking, “this fucking sucks!” and asking for drugs even though I was having a home birth. I was told I could have drugs if I went to the hospital and I cried, begging someone to go buy some drugs somewhere, didn’t someone have an old joint in a coat or something? When it was made clear the choice was the hospital and drugs or home and no drugs, I chose to stay home and birth – and I made it… I walked through the pain and when it came to the third child, I wasn’t afraid AT ALL that time.

BUT, I will say, what I learned from it, especially as a midwife, is to share with women that labor isn’t some “other-worldly” experience. Well, until I’d done birth work for many, many years and heard women speak romantically about birth, I was able to tell women it wasn’t an other-worldly experience. What I mean by that is that there isn’t this imaginary line between “Normal You” and “Labor You.” Labor slips quietly like period cramps… like “Period Cramp You” isn’t unlike “Normal You”, it’s just Normal You with period cramps. And period cramps are a lot less regular than contractions! There is rarely any rhyme or reason to period cramping, whereas labor cramps/contractions are clockwork rhyming.

Let me try again.

Walking into the ocean. At first, when you go in, the water is nippy and you might think, “Eek!” but within a few moments, it’s okay and you can go further in. With each forward movement into the water, it seems like you can’t possibly go further because it is so cold, yet acclimation occurs and you are able to move forward further still. Contractions are funky, you get used to them, they get funky again, you get used to them again... like that.

You’re doing your thing and the tightenings that have been happening your entire mature woman-life (your uterus contracts every single day of your life – more so during menstruation, orgasm, pregnancy, birthing and postpartum), just get regular and because your uterus is so big with a naked human being inside it, you feel it more, but you are still you. You don’t transform into some weird freaky Be-ing. In fact, for most women, they are perfectly sane and able to carry on normal conversations inbetween contractions. It is only during the contraction that the woman needs to concentrate/focus/moan. I remember saying during my drug-begging labor, “I could do jumping jacks!” when I was inbetween contractions. It was like that the whole time for me.

Yes, some women get “birth high,” but I think women who “let go” and “get into” their labors get birth high. I have watched hundreds of women have babies and not all women get – or want to get – birth high. It isn’t that the woman has to keep control, either, because the woman herself isn’t “in control,” but her body is in control and labor is a lot of getting out of the body’s way to let it do its thing.

That’s one thing I really like to remind women, that labor isn’t something happening TO you… it is YOU happening. It is the most incredible display of what your power is capable of – all without anyone else’s manipulations, machinations, or medications.

None of this addresses the issues of what is being called Primary Tokophobia – fears that occur before any birth has even happened and include everything from feeling a baby inside the body, fears of tearing, cutting the vagina, defecation during second stage, incontinence, the uncertainty of the outcome for the body, the anticipation of milk in the breasts, hemorrhoids, fears of any body changes including stretch marks, sagging breasts, pannus, labial changes and anything else that has already crossed your mind because I am sure every one of us has thought of some of these at least mildly. The difference for tokophobic women is that the intensity of feeling is multiplied a hundred-fold.

Secondary Tokophobia comes for women who have had a traumatic birth experience already. Whether she’s had a birthrape experience, an experience where she tore extensively, perhaps she had a large episiotomy, an instrumental delivery, a long labor followed by an emergency cesarean, a birth that required reconstructive surgery postpartum, a fetal death… any number of factors can send women into a place where the fear of another pregnancy or birth is immobilizing and they would do anything to avoid it.

I know that, for me, I can understand Secondary Tokophobia (ST) more than Primary Tokophobia (PT). It seems like at least the women gave it a shot and they know what they are talking about, but who says women have to “give it a shot” at all to know what they are talking about? Don’t women hear enough stories?

One of the biggest concerns I have is that so many women with PT say they watched movies that caused their phobia. It makes me SO angry that their only experience was watching the shit movies that I know they had to have seen – because I saw them, too (later, during childbirth classes). Why couldn’t they have been shown beautiful homebirth movies? Would that have changed the outcome of their psyches? I can’t help but believe so. Of course, there is no going back now, but I can suggest we stop scaring the crap out of all the future PT’s by taking birth shows off tv! I think I would have been a PT if I’d have watched Maternity Ward!

So, now we have this army of women with PT and ST and they are asking for general anesthesia cesareans.

(Contrary to what the last commentator believes, even cesarean women have lochia, so cesarean birthing women don’t wake up from surgery and head back to the office as if nothing happened. They still bleed for 4-6 weeks, just like vaginal birthing women. They are in a great deal of pain, just in a different location than vaginal birthing women… and 90% of vaginal birthing women are out of vaginal pain within a couple of days whereas post-cesarean moms are still in a great deal of pain at 2 weeks postpartum. Post-cesarean moms have bellies that are bigger longer than vaginal birthing moms, though just by a couple weeks, usually. I only share this information because cesareans aren’t the cure-all to a birth-afraid woman.)

Do we say, “Sure!” to women who ask for cesareans under general anesthesia? If we/the doctor/anesthesiologist explains the amazing risks for the mother and baby when using general anesthesia and why it is so rarely used and the mom still wants it, do we (as a community) support her choice? Do we support obstetricians who offer general anesthesia to women who request it? Do we send women to the OBs we know who support women with PT/ST? Do they become as popular as the ones that support the homebirth midwives? Do we supply doulas to PT/ST women to help them choreograph their births so they feel the most comfortable and get the safest birth possible? I mean, those of us who work in birth shouldn't withhold our knowledge just because we might have a different opinion, right?

How does this sit with you birthing women? How does this sound to the women with tokophobia? Is this the solution? To “de-criminalize” medicated cesareans? Would the support from us “crunchies” (as the article called us) help? Or do you even care if you have support from anyone. Do the women with tokophobia want to get rid of it? Or just want the rest of us to accept it as if you were coming out as lesbian or red-headed or something else un-changeable.

Where do we all go from here?