Should you have an elective c-section for tokophobia / pregnancy anxiety?

So, the consultant obstetrician I met at last week’s appointment has told me she’s willing to offer me an elective c-section.

And I’m thinking of taking it.

I realise this will be fairly shocking to quite a few of you. Most women, after all, live in absolute dread of the possibility of having to have a c-section: and I do, too, actually. I’m not going to pretend the prospect of surgery doesn’t terrify the life out of me, because trust me, it does. It’s just that the idea of natural childbirth scares me even more – and it always has.

My fear of giving birth is a lifelong one, and it’s one of the reasons I spent most of my adult life determined to remain childfree forever. It’s so bad, in fact, that within minutes of meeting the consultant (Who, to be fair, had already been prepped for the meeting by my midwife…), she’d very kindly told me that what I have sounds very much like tokophobia: an extreme fear/phobia of childbirth.

This wasn’t news to me, by the way. I’d read enough about tokophobia over the years to know that I tick pretty much all the boxes for it, and I also knew that many women who suffer from tokophobia end up having elective c-sections: not because they’re “too posh to push” (God, I HATE that phrase!), but because they’re just too terrified of the alternative to even be able to contemplate it.

As strange as I know that probably sounds to those who DON’T have this phobia, this makes perfect sense to me. The thing is, most people, when hearing about my health anxiety, assume it means I’m scared of medical procedures – that I’m probably terrified of needles, and faint at the sight of blood or something. Actually, though, while it’s true that I’m not overly fond of those things (I watch a lot of TV shows through my fingers these days), I can generally grit my teeth and deal with them if I have to. No, what I fear most is the complete loss of control I associate with childbirth and hospitalisation – that chaotic, long-drawn out trauma I’ve read about in so many birth stories now, and which I’m absolutely certain I will not be able to cope with.

I’m terrified of the pain: of the contractions, the pushing, all of it. I know people tell you that it’s OK, because you just “forget” the pain once it’s over, but, I am not other people – and, of course, the idea that I might forget it at some point in the future doesn’t really help me NOW, does it?

I’m scared of all of the things that can go wrong: the tearing, the haemorrhaging, the word “episiotomy” and all that it entails. (Er, don’t Google that last one if you have any degree of anxiety AT ALL: trust me on this…)

I’m frightened of having to be induced: of being in hospital for days waiting for it to take effect, and of being totally alone for much of that time. (The consultant confirmed that the hospitals in our area all have a “no partners” policy for everything other than active labour, so if I did have to be induced, I’d be on my own, with all of my anxieties…) Even if I DON’T have to be induced, I’m worried about those labours that seem to last for days, and can’t imagine how on earth I’d cope with a prolonged period of pain/loss of control. “Not well,” would seem to be the most obvious answer to that one…

Most of all, I’m absolutely terrified – to the point of having nightmares from which I wake up in a cold sweat – of having to have a general anaesthetic. This is a full-blown phobia for me, so my biggest fear – other than, well, DEATH by childbirth, obviously – is that some scenario crops up which leads to me having to have an emergency c-section, involving me being rushed to theatre in a panic, and immediately “put under”. I’m hyperventilating just thinking about it, seriously.

Oh yeah, and I’m also scared of DEATH – either mine or the baby’s – obviously. But that goes without saying, doesn’t it?

So, now that I’ve made myself sound absolutely insane, three quick points about all of this:

Yes, I’m getting counselling. Next week, in fact.

Yes, I’m going to be doing hypnobirthing.

Yes, I know that most – if not ALL – pregnant women have these fears, to a greater or lesser extent.

I mean, childbirth is probably one of the most extreme things any of us will ever put our bodies through, so I guess it’s pretty natural to be at least a little bit afraid of it, isn’t it?

Fears, however, are not the same as phobias, and tokophobia goes far beyond the natural level of fear most women have. I mean, I know that, in all likelihood, I’m probably going to get a lot of responses to this post from people telling me it’s not that bad, that I’ll just deal with it the way everyone else does, and that I’m “stronger than I think”. All I can say to that, though, is that unless you’ve dealt with an ACTUAL phobia, you can’t really understand how impossible it is to just rationalise it away like that (And also that no one who knows me in real life thinks that I’m “stronger than I think” or believes that I’ll cope just fine with childbirth – seriously!) – which is one of the reasons I went into last week’s appointment feeling pretty sure that I wanted an elective c-section, and that, if I was offered one, I’d accept on the spot.

Why? Well, as I said, I’ve read – and been told – a lot of birth stories over the years. They’re all different, of course, but one of the things the elective c-sections tend to have in common is the fact that they’re often described as “calm”, fairly positive experiences, which are over relatively quickly. Yes, it’s major surgery, and the recovery process can be longer and harder, but, for the most part, it seems to me to be the only real option where I’d go into hospital knowing exactly what to expect. (Er, other than a baby, obviously.) Most crucially for me, I also knew that most elective c-sections are done under a spinal block these days, as opposed to a general anaesthetic, so while there are no guarantees with ANY form of birth – and the doctor was very keen to stress that to me – this option does offer me the best chance of avoiding my biggest second-biggest fear.

Just to add to this – and, again, I’m prepared to be judged harshly for this admission – I have absolutely no desire whatsoever to experience natural birth. None. I’ve said this before, but I got pregnant because I wanted a baby, not because I wanted a birth experience, and my main aim for the birth is for both of us to get through it alive. If that can also happen in the least-traumatic way possible, then that would be even better, as far as I’m concerned.

I know that’s not a popular opinion. I know I’m supposed to want to know what it’s like to push a baby out of my body: to experience the pain, and to prove I can deal with it. I just don’t, though. I mean, fair play to anyone who DOES want those things, and I cast no judgement here at all: I just don’t relate to those feelings in the slightest. So I won’t feel like a failure, or less of a woman/mother if I don’t have a natural birth: I don’t view childbirth as a competition, and I know I won’t feel like I’ve let the side down, or am “missing out” if my experience is quicker and less painful than someone else’s.

Literally ALL I want is a safe, health baby – and to not die having him. Which made an elective c-section seem like the obvious choice for me, really.

So, I went into the appointment thinking I knew what I wanted, and that it was a planned c-section. I left the appointment feeling 100% sure that I can’t POSSIBLY have a c-section, and that, actually, there is no possible way of getting this baby out of me in a way that doesn’t scare me half to death, so he’ll just have to stay in there forever. Sorry, baby!

None of this was the doctor’s fault, I hasten to add. Quite the opposite, really: she was, as my midwife had told me, absolutely lovely, and very, very understanding of my anxieties – she didn’t even mind when I started crying when I was trying to explain the whole, “I’ll definitely die if I have to have a general anaesthetic,” thing. In fact, she listened carefully to what I had to say, agreed that planned c-sections can be a good option for people with my level of anxiety, and told me that, if that’s what I decide I want, she will support me 100%.

She also, however, asked me to think it over some more, and told me that she wouldn’t be doing her job properly unless she outlined some of the risks, which are as follows:

[TRIGGER WARNING: I’m guessing this was probably clear from the title, but just in case it wasn’t, the rest of this post will probably be triggering if you have tokophobia or health anxiety, or are facing a c-section and worried about it!]

01.
Risk of death or serious complications to me or the baby

And, I mean, I’m not stupid: I was obviously aware that any kind of surgery carries a risk, but somehow hearing an actual doctor say it really scared me, and, well, I cried all the way back to the car. Yes, really. My big fear here is that I bleed to death on the table – which the doctor told me is highly unlikely – but I was also really upset when she mentioned a small risk of the baby being cut during the surgery, or having breathing difficulties, which I just don’t think I could stand.

Of course, while there is a risk of Very Very Bad Things happening during surgery, my doctor was also quick to reassure me that that doesn’t mean the risk is a terribly high one, if that makes sense? The fact is that most c-sections are straightforward, most people DON’T die during them, and while there is obviously going to be bleeding, my general health is good, and there’s nothing to suggest – no, not even the fact that I’m a redhead, and yes, I did ask! – that I’d be taking a huge risk by going ahead.

It’s also worth mentioning – although the doctor did NOT tell me this, as I’m assuming they’re not supposed to – that although there are obvious risks associated with surgery, it doesn’t follow that there are NO risks at all with a vaginal birth. Both options come with risks, so choosing a vaginal birth doesn’t mean I’m guaranteed an easy run of it: I could still haemorrhage, I could still have complications – I could still, in fact, end up having to have a c-section ANYWAY, even with the best will in the world. So that’s… reassuring. Not.

02.
Slower recovery time with a c-section

Again, I already knew that c-sections are typically harder to recover from, but I’d kind of discounted that, on the basis that, “Well, the worst will be over by then, and I’ll have my baby, so I’m sure I’ll cope!” HAHALOL.

Actually, I still feel a LITTLE bit like that, to be honest, although, having taken the time to think about it some more, I’m a little more daunted by the prospect of a long recovery than I was previously. I’m very lucky in that, despite all of my anxieties, I’ve always been a fairly fit, healthy person, and some of the information I’ve read has made it sound like I’d basically be unable to function for a couple of weeks afterwards, which is scary. I’ve also read a few really horrific stories about c-section recoveries which involved unbearable pain, and people being rushed to hospital thinking they were dying, only to discover that it was actually just trapped wind. Which sounds very, very un-fun, no?

I suppose I should also add here, and sorry for repeating myself, but I have to say again that while the recovery from a natural birth is normally much faster and more straightforward, that’s not guaranteed either, and I do know of people who had very traumatic vaginal births, which took a long time to recover from. It’s maybe not likely, but that doesn’t mean it definitely won’t happen.

03.
Risk of DVT

OK, so this one scared the crap out of me. DVT is one of my big health-anxiety fears (In fact, I’m pretty sure it was the thing that kicked it all off): I worry about it far more than is reasonable, and there’s a part of my brain that’s totally convinced I will one day be going about my business and just drop dead from a blood clot (I actually once had a colleague who this happened to…), so the news that THAT DAY COULD BE COMING SOON freaked me out pretty badly.

So, yeah, there’s a higher risk of DVT with surgery. I’d be wearing surgical stockings for the procedure, which is fine, but I’d also be sent home with a series of injections which I’d – get this – HAVE TO ADMINISTER MYSELF. Which, HAHA, NOPE. I mean, it’s really cute that my doctor thinks I could give myself an injection, but there’s absolutely zero chance of that happening: I’m actually NOT scared of needles when someone else is on other end of them, but the thought of having to puncture my own skin makes me want to pass out with fear – as does the thought of basically being a ticking time-bomb, just waiting to drop dead. (Which, yes, is how health anxiety works. It’s not how NORMAL people work, I know, but… let’s just end that train of thought there, shall we?)

Terry has bravely offered to step up and do this for me. I am still not keen. Moving on…

04.
More time in hospital afterwards

This is something that people always use as an argument against c-sections, so it’s another one I was already aware would be thrown at me (Actually, I’d done my research, so really none of this – other than the injections part – was news to me: as I said, it’s just that having it all laid out in front of me by a doctor, in the context of, “These things could actually happen to YOU, Amber,” made it all a lot more REAL, somehow…). This time, though, I have my response ready-prepared, because what most people who make this argument seem to forget is that while it’s true that most women who have c-sections have longer hospital stays AFTER the birth, women who have vaginal births are generally in hospital for much longer BEFORE the baby arrives, particularly if they have to be induced. I have two friends, meanwhile, who had natural births, and were in hospital for two weeks afterwards: that’s obviously not the most common outcome, but it does happen, and there are no guarantees it won’t happen to me.

In my case, I have a huge fear of hospitals, for reasons that would take too long to go into here, so I’m obviously really keen to minimise the time I spend in one. Given that I can’t avoid it completely, though (My anxiety dictates that, although I hate hospitals, I do want to give birth in one, so a home birth isn’t an option I’m considering …), if I have to be in hospital, I’d still rather be there AFTER the birth – when the “worst” will be behind me – than before it, when the anticipation of what’s to come is liable to turn me into a nervous wreck, and make everything seem 100x worse. My biggest fear here, as I’ve said, is one of those never-ending inductions (Which seem to be frighteningly common, by the way: almost all of my friends have had to be induced, which makes me wonder if ANYONE actually goes into labour spontaneously, or if that’s just in the movies?) during which Terry would be sent home, and I’d be left all on my lonesome – nuh uh. My doctor has already told me that, due to my age, they wouldn’t be keen to let me go much beyond 40 weeks, which, given that first babies are often late, means I’d be more likely to need one, too. Awesome!

Also, although she did give me the whole “longer time in hospital” speech, my doctor was also quick to reassure me that, with elective c-sections, they’re done first thing in the morning, and, assuming all goes to plan the average stay in our local hospital is just one night – even I could cope with that, surely?

* * *

So. As I write this, I’m sitting here with the paperwork in front of me which would allow me to formally request an elective c-section, if I decide I want one. I’m just… not sure I do, really. The problem is, though, that I don’t want a vaginal birth, either – and I really, REALLY don’t want to either be induced, or end up having an emergency c-section. So, rock, hard place, ME, basically. And I know that ultimately people are just going to tell me I should “do what’s best for me” – but what about when you don’t actually KNOW what’s best for you? What then?

There are, however, some things in place to help me make up my mind:

01.
I have my first counselling appointment next week.

It’s in the hospital, which strikes me as almost hilariously stupid (I mean, sure, let’s tell the woman who’s scared of hospitals that we can only help her IN THE HOSPITAL!), but hopefully it’ll help. I mean, it never has before, to be honest – and seriously, if they make me fill out that freaking multiple-choice questionnaire they use to diagnose anxiety ONE MORE TIME, I swear I’ll scream – but we can but hope. My main issue with counselling in the past, however, has always been that I get very emotional when I try to actually TALK about my issues, so I generally start crying, and find it really hard to express myself, at which point I start to downplay my fears, or just blindly agree that yes, I expect I’ll be totally fine, just to get out of there. So, in that respect, I guess posts like this one are a kind of therapy for me. I REALLY hope y’all don’t charge by the hour…

02.
Hypno-birthing.

Which will apparently help me whichever kind of birth I end up having, although probably not so much with the “I’ll just stay pregnant forever, thanks,” plan I’ve been harbouring

03.
The doctor is arranging for me me to speak to an anaesthetist, who will talk me through what would happen if I did have surgery.

I’m a little nervous about this, not only because it has the potential to be hugely triggering for me, but also because I honestly have no idea what to even ask, other that, “Can you promise me you won’t kill me?” Which might not be all that tactful, really?

04.
Tour of the labour ward.

The doctor is also arranging for me to go to the labour ward, see the facilities, and speak to the staff there, who will hopefully help put my mind at ease. A lot of this is geared towards helping with my general fear of hospitals, which encompasses a lot more than just the, “What if I die?” stuff I’ve mentioned here: in particular, I’m worrying a lot about the isolation, if they really do force me to go it alone for a large part of the process, and I also really worry about the loss of privacy/control etc I’ve witnessed in hospitals. In our area, you can’t book private rooms in advance, and even if you do get one, partners aren’t allowed to stay in them with you outwith visiting hours: my doctor and midwife have told me they’ll do their best to see if an exception can be made on the grounds of my extreme anxiety, but they have warned me that it’s not hospital policy, and that it can never be guaranteed. These are obviously minor concerns compared to everything else, but I have considered going private, just so I can stop worrying about them: unfortunately it seems I’d have to sell a kidney to be able to afford it, and hey, that would require a hospital stay! And a general anaesthetic! And surgery! So, yeah, maybe not.

So. If you have any positive birth stories – of any kind – I would love to hear them right now. And, similarly, if you died on the operating table, and are reading this from beyond the grave, maybe you could take pity on me, and just keep that story to yourself… for now?

UPDATED TO ADD:

For those of you who’ve just stumbled upon this post a few years after it was written, and who’re wondering what I decided in the end, Max’s birth story is here, and you’ll find some more thoughts and information on the subject of pregnancy and tokophobia here.