11-27-2010, 10:58 AM
Wow! Why are women so judgemental towards one another? Now women are being chastised for giving birth the wrong way?
'I was terrified of giving birth'
Stephanie Calman suffers from tokophobia – fear of childbirth. She chose to have her children by caesarean section and can't understand why women like her are made to feel like failures
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Stephanie Calman
The Guardian, Saturday 20 November 2010
Article history
A baby delivered by caesarean section in a dimmed operating theatre. Photograph: Sarah Lee for the Guardian
When my children asked where they came from, I said: "From my tummy." It wasn't a euphemism. I am one of an apparently growing number of women who choose to give birth by caesarean section. Over recent years, concern has mounted about the rate of caesarean deliveries in the UK, which has more than doubled since the 1980s. The feeling is that there are too many and that an increasing proportion of these are "unnecessary".
So it may come as a shock that the proportion of elective caesareans is very small – according to the largest study into this area, no more than one in 10. A survey of 620,604 births in 146 NHS trusts was carried out in 2008 and published by the British Medical Journal this year. It found that 147,726 deliveries were by C-section, or 23.8%, and that there was "no evidence that low-risk women were being given C-sections inappropriately".
So, the supposed epidemic of loud-voiced, sharp-elbowed career women clogging up the nation's operating theatres is a myth. For me the survey comes as a huge relief. As the mother of two children born by elective caesarean, I've often wondered why women in my position come in for so much flak. "Unnecessary" isn't the half of it. I've been called "too posh to push" even by women I think of as friends. The "posh" bit is particularly weird, almost as if by avoiding labour you're assumed to be heartless and arrogant. I'm a coward, but not a manor-house-owning, green-welly-wearing one. And even if I were, don't they have feelings too? This sort of prejudice occurs nowhere else in healthcare, only childbirth. You don't get criticised on the basis of your socio-economic background, real or imagined, for having an anaesthetic at the dentist.
I wasn't going to have children. Although at the time I didn't know there was a word for it, I suffered from tokophobia – the extreme fear of labour. Tokophobia inspires less understanding than the fear of spiders, crowds, lifts – almost any other terror. How can anyone be so neurotic as to fear something so natural?
It can be triggered by a shocking experience in childhood, such as seeing an explicit video of a baby being born. However unpalatable it is to some ardent natural-birthers, children are likely to be terrified by seeing a woman screaming and bleeding, even in a good cause. The actor Helen Mirren attributes her childlessness to such a film seen at school. Sexual abuse and rape are also causes; an internal examination, let alone a birth, can bring on flashbacks.
Tokophobia can be primary and secondary. It's the latter, the result of a previous traumatic birth, that is on the rise, and which has led the NHS to announce plans this week for more specialist support services to help keep caesarean figures down. Among the responses have been accusations that women are increasingly "reluctant" to deal with pain. I would counter that they're finally finding the courage to ask for what they want. I've known women who were badly stitched up causing them permanent pain during intercourse, or left semi-continent by damage to the perineum. Some couldn't face another birth. Typically they had kept it a secret, even from their intimates. In two instances, my admission that I had chosen an elective caesarean seemed to let them off the hook and they described their experiences – but shamefully, as if the "failure" to have a marvellous birth was all their own. The emotional damage was perhaps worse than the physical; two had remained on the antidepressants prescribed at the time, which had done nothing to assuage the guilt and anger. And all had one thing in common, whether they delivered "naturally" or not: the gap between expectation and reality had been too great. And they had been treated insensitively, even cruelly, by doctors or midwives (or both), resulting in a complete loss of control.
Some years ago, I accompanied a friend to the then newly opened Birth Injuries Clinic in London and only on that day, 10 years after the event, learned the source of her postnatal depression. She had suppressed her anger for so long that even attending the clinic took considerable courage. Having had two elective C-sections, I was perhaps the only person she could trust not to say, "Well, it's over now, you've got a child: what does it matter?" The medical staff at the time were dismissive; if lots of women have stitches, why should one "make a fuss"? Yet statistics are useless here. We all lose our parents at some point: does that mean bereavement doesn't hurt? The term post-traumatic stress disorder appears in the tokophobia study, suggesting that we seriously underestimate the effect of this most personal of wounds.
When I first alerted my mother that she might never have grandchildren – at least not from me – she said kindly: "Oh, I was scared too: don't worry. You'll manage it. It'll be all right."
Mum had learned how to breathe from the doyenne of natural birth, Betty Parsons, who later taught Diana, Princess of Wales. As a press officer at the National Childbirth Trust, she helped spread the word right at the start, in the late 50s, when it was still the Natural Childbirth Trust. It was a family joke that Mum thought everything – childbirth, broken legs, nuclear war – could be overcome if you just did Betty's breathing.
I dreamed of being a mother, but without the right man, pushed the decision to the back of mind. When I met Peter, and we married, his compassion and commitment led me to hope that somehow, I might be able to have a child. And as I hit 35, the fear of missing out on motherhood grew stronger. I felt paralysed, and that I was running out of time.
Then we stumbled on a newspaper article about elective caesareans, which sounded nothing like emergencies. Could this be the solution?
I got pregnant and was terrified but overjoyed. Peter was determined to help me lift the burden of anxiety so I could enjoy the pregnancy and the baby. Surely the aim was to have a child, not to win points for suffering? He consulted an old friend who had had three caesareans, the first an emergency, the others elective. And she recommended her obstetrician at University College London Hospital.
Expectant mothers don't normally see consultants – it's like suddenly asking for the manager in a restaurant where the food and service are fine. So we decided to discuss my fears with no one except him. I told him I was petrified, that every examination, every smear test, ended in shaking and tears. He listened intently and said: "Have you considered a caesarean section?"
The relief was incredible.
Not everyone I met was as positive.
"You won't be able to pick up your baby," I was told. And: "If the baby isn't born properly, its lungs won't clear." And: "If you don't give birth you don't produce oxytocin and can't bond." Women who had emergency caesareans apparently had no problem feeding, lifting and bonding with their babies. Really? Such a difference after the same operation?
Anna is a friend whose consultant recommended a section early on in what looked to be a very long and difficult delivery. It was his judgment but, being 39 at the time, she was relieved. Though any section begun during labour is classified as an emergency, she was afraid of how people would react. "I don't want them to think I didn't try."
She only told me because I booked mine in advance and so was even guiltier. Who can blame her? Society's view of this most personal, subjective experience is more akin to a religious belief system than rational understanding. And among mothers as well as professionals there can be a disturbing streak of sadism. As my friend Ella once put it: "Some of the anti-caesarean feeling almost implies that they have suffered so they don't see why you shouldn't as well." I felt this too.
But we must live and let live. More and more of us now start our families after the age of 35; 47% of all births are now to women over 30, leading to an inevitable rise in intervention. Our bodies tire faster, making birth too slow and an emergency caesarean more likely. Yet women are still being misled about the risks. Some antenatal groups and midwives portray even an elective caesarean as the most dangerous method, when it is not. In practice, you are more likely to be scared into a vaginal delivery than out of one.
Pat O'Brien, a senior consultant obstetrician, says the risks of elective c-section are routinely exaggerated, partly because the elective and emergency risk probabilities are often lumped together despite being different. "If we profess to offer women choice, we owe it to them to tell them all the options," he says firmly. "It is wrong for any doctor or midwife to present these risks in a biased way based on their own personal beliefs or prejudices."
Dr Jan Grace, a consultant gynaecologist and former obstetrician who is also a mother of five, agrees: "The advances in medicine have been to look after women with complications that used to kill them, but don't kill them any more. Some antenatal groups, such as the NCT, can make people feel that they've failed if they don't have a completely 'natural' birth. And, of course, those with birth plans saying 'no pain relief, no intervention' can need intervention if it goes wrong."
The key word in all of this is "natural"; if you have help, you can end up feeling that your birth is unnatural and therefore somehow wrong. It is just absurd. Death from postpartum haemorrhage is natural; worldwide, it kills 100,000 women a year. So are malaria, polio and diarrhoea. All medical procedures involve risk – as does childbirth itself. So why aren't we delighted to be living in a time and place where it's so safe?
For those who manage it, natural birth bestows a huge sense of achievement, and rightly so. But to exaggerate the risks of giving birth any other way is not playing fair.
We are all different and surely none of us deserves to suffer for no reason. Our babies are all different and we love them equally. Can't we feel the same about our births?
http://www.guardian.co.uk/lifeandstyle/2...rth-phobia
'I was terrified of giving birth'
Stephanie Calman suffers from tokophobia – fear of childbirth. She chose to have her children by caesarean section and can't understand why women like her are made to feel like failures
Share
19
Comments (45)
Stephanie Calman
The Guardian, Saturday 20 November 2010
Article history
A baby delivered by caesarean section in a dimmed operating theatre. Photograph: Sarah Lee for the Guardian
When my children asked where they came from, I said: "From my tummy." It wasn't a euphemism. I am one of an apparently growing number of women who choose to give birth by caesarean section. Over recent years, concern has mounted about the rate of caesarean deliveries in the UK, which has more than doubled since the 1980s. The feeling is that there are too many and that an increasing proportion of these are "unnecessary".
So it may come as a shock that the proportion of elective caesareans is very small – according to the largest study into this area, no more than one in 10. A survey of 620,604 births in 146 NHS trusts was carried out in 2008 and published by the British Medical Journal this year. It found that 147,726 deliveries were by C-section, or 23.8%, and that there was "no evidence that low-risk women were being given C-sections inappropriately".
So, the supposed epidemic of loud-voiced, sharp-elbowed career women clogging up the nation's operating theatres is a myth. For me the survey comes as a huge relief. As the mother of two children born by elective caesarean, I've often wondered why women in my position come in for so much flak. "Unnecessary" isn't the half of it. I've been called "too posh to push" even by women I think of as friends. The "posh" bit is particularly weird, almost as if by avoiding labour you're assumed to be heartless and arrogant. I'm a coward, but not a manor-house-owning, green-welly-wearing one. And even if I were, don't they have feelings too? This sort of prejudice occurs nowhere else in healthcare, only childbirth. You don't get criticised on the basis of your socio-economic background, real or imagined, for having an anaesthetic at the dentist.
I wasn't going to have children. Although at the time I didn't know there was a word for it, I suffered from tokophobia – the extreme fear of labour. Tokophobia inspires less understanding than the fear of spiders, crowds, lifts – almost any other terror. How can anyone be so neurotic as to fear something so natural?
It can be triggered by a shocking experience in childhood, such as seeing an explicit video of a baby being born. However unpalatable it is to some ardent natural-birthers, children are likely to be terrified by seeing a woman screaming and bleeding, even in a good cause. The actor Helen Mirren attributes her childlessness to such a film seen at school. Sexual abuse and rape are also causes; an internal examination, let alone a birth, can bring on flashbacks.
Tokophobia can be primary and secondary. It's the latter, the result of a previous traumatic birth, that is on the rise, and which has led the NHS to announce plans this week for more specialist support services to help keep caesarean figures down. Among the responses have been accusations that women are increasingly "reluctant" to deal with pain. I would counter that they're finally finding the courage to ask for what they want. I've known women who were badly stitched up causing them permanent pain during intercourse, or left semi-continent by damage to the perineum. Some couldn't face another birth. Typically they had kept it a secret, even from their intimates. In two instances, my admission that I had chosen an elective caesarean seemed to let them off the hook and they described their experiences – but shamefully, as if the "failure" to have a marvellous birth was all their own. The emotional damage was perhaps worse than the physical; two had remained on the antidepressants prescribed at the time, which had done nothing to assuage the guilt and anger. And all had one thing in common, whether they delivered "naturally" or not: the gap between expectation and reality had been too great. And they had been treated insensitively, even cruelly, by doctors or midwives (or both), resulting in a complete loss of control.
Some years ago, I accompanied a friend to the then newly opened Birth Injuries Clinic in London and only on that day, 10 years after the event, learned the source of her postnatal depression. She had suppressed her anger for so long that even attending the clinic took considerable courage. Having had two elective C-sections, I was perhaps the only person she could trust not to say, "Well, it's over now, you've got a child: what does it matter?" The medical staff at the time were dismissive; if lots of women have stitches, why should one "make a fuss"? Yet statistics are useless here. We all lose our parents at some point: does that mean bereavement doesn't hurt? The term post-traumatic stress disorder appears in the tokophobia study, suggesting that we seriously underestimate the effect of this most personal of wounds.
When I first alerted my mother that she might never have grandchildren – at least not from me – she said kindly: "Oh, I was scared too: don't worry. You'll manage it. It'll be all right."
Mum had learned how to breathe from the doyenne of natural birth, Betty Parsons, who later taught Diana, Princess of Wales. As a press officer at the National Childbirth Trust, she helped spread the word right at the start, in the late 50s, when it was still the Natural Childbirth Trust. It was a family joke that Mum thought everything – childbirth, broken legs, nuclear war – could be overcome if you just did Betty's breathing.
I dreamed of being a mother, but without the right man, pushed the decision to the back of mind. When I met Peter, and we married, his compassion and commitment led me to hope that somehow, I might be able to have a child. And as I hit 35, the fear of missing out on motherhood grew stronger. I felt paralysed, and that I was running out of time.
Then we stumbled on a newspaper article about elective caesareans, which sounded nothing like emergencies. Could this be the solution?
I got pregnant and was terrified but overjoyed. Peter was determined to help me lift the burden of anxiety so I could enjoy the pregnancy and the baby. Surely the aim was to have a child, not to win points for suffering? He consulted an old friend who had had three caesareans, the first an emergency, the others elective. And she recommended her obstetrician at University College London Hospital.
Expectant mothers don't normally see consultants – it's like suddenly asking for the manager in a restaurant where the food and service are fine. So we decided to discuss my fears with no one except him. I told him I was petrified, that every examination, every smear test, ended in shaking and tears. He listened intently and said: "Have you considered a caesarean section?"
The relief was incredible.
Not everyone I met was as positive.
"You won't be able to pick up your baby," I was told. And: "If the baby isn't born properly, its lungs won't clear." And: "If you don't give birth you don't produce oxytocin and can't bond." Women who had emergency caesareans apparently had no problem feeding, lifting and bonding with their babies. Really? Such a difference after the same operation?
Anna is a friend whose consultant recommended a section early on in what looked to be a very long and difficult delivery. It was his judgment but, being 39 at the time, she was relieved. Though any section begun during labour is classified as an emergency, she was afraid of how people would react. "I don't want them to think I didn't try."
She only told me because I booked mine in advance and so was even guiltier. Who can blame her? Society's view of this most personal, subjective experience is more akin to a religious belief system than rational understanding. And among mothers as well as professionals there can be a disturbing streak of sadism. As my friend Ella once put it: "Some of the anti-caesarean feeling almost implies that they have suffered so they don't see why you shouldn't as well." I felt this too.
But we must live and let live. More and more of us now start our families after the age of 35; 47% of all births are now to women over 30, leading to an inevitable rise in intervention. Our bodies tire faster, making birth too slow and an emergency caesarean more likely. Yet women are still being misled about the risks. Some antenatal groups and midwives portray even an elective caesarean as the most dangerous method, when it is not. In practice, you are more likely to be scared into a vaginal delivery than out of one.
Pat O'Brien, a senior consultant obstetrician, says the risks of elective c-section are routinely exaggerated, partly because the elective and emergency risk probabilities are often lumped together despite being different. "If we profess to offer women choice, we owe it to them to tell them all the options," he says firmly. "It is wrong for any doctor or midwife to present these risks in a biased way based on their own personal beliefs or prejudices."
Dr Jan Grace, a consultant gynaecologist and former obstetrician who is also a mother of five, agrees: "The advances in medicine have been to look after women with complications that used to kill them, but don't kill them any more. Some antenatal groups, such as the NCT, can make people feel that they've failed if they don't have a completely 'natural' birth. And, of course, those with birth plans saying 'no pain relief, no intervention' can need intervention if it goes wrong."
The key word in all of this is "natural"; if you have help, you can end up feeling that your birth is unnatural and therefore somehow wrong. It is just absurd. Death from postpartum haemorrhage is natural; worldwide, it kills 100,000 women a year. So are malaria, polio and diarrhoea. All medical procedures involve risk – as does childbirth itself. So why aren't we delighted to be living in a time and place where it's so safe?
For those who manage it, natural birth bestows a huge sense of achievement, and rightly so. But to exaggerate the risks of giving birth any other way is not playing fair.
We are all different and surely none of us deserves to suffer for no reason. Our babies are all different and we love them equally. Can't we feel the same about our births?
http://www.guardian.co.uk/lifeandstyle/2...rth-phobia