Client terrified of birth - Page 2

[doctorjen]

Looks like there are a few doulas about an hour away. I'll print that list and give it to her. Does anyone have a good link to a brief description of the benefits of doula services?
Her boss had been planning to attend childbirth classes with her. Think it would help to have her (the boss) read "The Birth Partner"?
I like the idea of having her write down her fears, pam. Maybe I could have her do some of that prior to an appt, then we could go over it together.
Her level of terror really does make me think there might be something repressed going on, but other than asking about it and encouraging her to think about it, I don't know how to find it.
Unfortunately, we suffer from a serious lack of decent counseling services around here, too.
I did not mean to say that her fears were baseless when I mentioned her fear of not being able to get away from the pain. I've taken care of enough folks for who the epidural didn't work, or they could feel enough sensation with it to be bothersome, that I don't want to encourage her to just have all faith in a medical intervention.
When she talked about watching the childbirth movie, she was really upset by the woman on the film being in pain and looking "miserable." Yet, the woman in the film didn't want pain medicine. I encouraged her to consider that things feel differently when you are experiencing them than when you are watching them.
I also encouraged her to talk to her cousin, who I attended last July, about her labor. The cousin had a short, very intense, like being run over by a freight train labor, and pushed out a nearly 9 lb baby (first baby.) Watching her labor, and throw up repeatedly, moan, scream, and change position every 3 seconds, she really did look pretty miserable. Later, though, when this woman described her birth to me she spoke of feeling "content" and "well-supported" and "in-control." Which honestly, from the outside, was not at all how it looked. Maybe hearing that from someone who's been there might help?

[Noelia430]

I was also going to suggest HypnoBirthing. We do a fear release during the 3rd class that really helps the moms (and dads) release any negative feelings they have about labor and birth. I can write to my HypnoBirthing yahoo group and see if there are any Practitioners in your area. She could even just seek out a hypnotherapist that can do a fear release if she doesn't want to go through the series of classes. Where in Illinois are you located?

[onlyboys]

Good suggestions, all.

I also agree that if any doc can help this woman, it's you doctorjen.

Perhaps, since she was so stimulated by the visual images she saw at CBE classes, you could recommend to her renting from the library some videos that show births with mamas who feel really good about birthing. I'd suggest the video of my 3rd birth, where I was happily laboring, until I started pushing, when things got serious. I guess I mean to say, I don't look miserable; I don't look like I'm in pain. I look like I'm working really, really hard.

Are there any videos that show that kind of birth?

How about ecstatic birth?

It might be useful for her to see these images--women birthing who are happy about doing so--then she can integrate these into her fears and perhaps dissuade herself from being so fearful.

It's a hard situation. Keep us posted.

[ZeldasMom]

nak

Lots of great ideas already mentioned.

i can relate to this woman somewhat. i remember seeing a birth video in health class in hs and deciding then and there i was never having a baby (maybe that's the effect they were hoping for!).

What helped my confidence about birth tremendously was reading UC stories. Knowing there were women out there who trusted their bodies that much really helped. When I was pregnant I also did not watch any of those birth shows on cable and I did not read random birth stories online that included horror stories. I agree with pps who talked about confronting fears and getting prof support with that, but at the same time I think you need to start building a positive picture/gestalt of birth in your head. Address your fears, but don't go adding new ones.

It helped me to think of birth as something I was going to do, rather than something that was done to me. My big thing is I don't like having medical procedures done to me, especially when I feel out of control with how they're done. This may be why the UC stories appealed to me so much.

It helped a lot to work on building a "tool box" of coping strategies for labor. Then I wasn't this passive victim preparing for things that were going to happen to me. I was was actively working on things I could do to get through the experience. I like Penny Simkin's videos. She is such a calming, emotionally anchoring person. If you show her The 3Rs: Relaxation, Rhythm, and Ritual (not too expensive!) have someone who knows about birth watch it with her. The Birth Partner has lots of practical info about techniques you can do to cope with labor that might help redirect some of her anxiety. Penny also recently wrote a book titled When Survivors Give Birth about attending the births of women who have been sexually abused. I have not read this, but you may find some help there with this situation:
http://www.amazon.com/exec/obidos/tg...books&n=507846

I agree with seeing if you can get a doula who will travel. My experience has been that doulas tend to be strongly committed women--I bet someone would do it. I would maybe refer to her as a labor support person to the hospital staff rather than doula. Also, I brought cookies for the nurses (enough for 2 shifts) when I was bringing a doula into a conservative hospital, and I think that helped.

edit: you asked for brief info about the benefits of having a doula:
http://www.dona.org/PDF/EffectsofBirthDoula.pdf
Go to the consumer info section of the DONA web site if this isn't quite what you were looking for.

[ZeldasMom]

Originally Posted by onlyboys

you could recommend to her renting from the library some videos that show births with mamas who feel really good about birthing. I'd suggest the video of my 3rd birth, where I was happily laboring, until I started pushing, when things got serious. I guess I mean to say, I don't look miserable; I don't look like I'm in pain. I look like I'm working really, really hard.

Are there any videos that show that kind of birth?

How about ecstatic birth?

Your post reminded me that Ina May's Guide to Childbirth talks about women who have this experience. There is also a pic of a woman smiling/experiencing birth ecstasy while her baby is crowning (page 162).

[ktmama]

These are all great suggestions (of course, it's MDC!)

I'd also add that she might explore some biofeedback training. I'm sure there are lots of therapists that offer it, maybe even at the hospital. It simply teaches people to practice having control over their heartrate and breathing and this can help someone feel more in control of anxiety, fear and pain. My sister practices biofeedback for panic attacks and it has helped her tremendously. Also, does anyone know anything about EMDR? My understanding is that it's a way of erasing the effects of past trauma without actually having to mentally or emotionally "process" it.

She's lucky to have you Dr. Jen!

[MrsMoe]

I know many on this forum are very anti-hospital, and pain medication... but in this case perhaps an epidural is in order.

A woman that accepts pain medication is not weak. She isn't lesser than a woman who has natural childbirth, nor should she feel ashamed.

Not all people have a spine of steal, and that is why epidurals are out there.

My daughter was delviered naturally, but that doesn't mean that my girlfriend who had an epidural is a lesser person because she cannot tolerate pain.

Just a suggestion.

[onlyboys]

Originally Posted by MrsMoe

I know many on this forum are very anti-hospital, and pain medication... but in this case perhaps an epidural is in order.

A woman that accepts pain medication is not weak. She isn't lesser than a woman who has natural childbirth, nor should she feel ashamed.

Not all people have a spine of steal, and that is why epidurals are out there.

My daughter was delviered naturally, but that doesn't mean that my girlfriend who had an epidural is a lesser person because she cannot tolerate pain.

Just a suggestion.

Jen thinks her client will certianly have an epidural, but she's concerned about the possibility that the epi will not take effectively, and then she's left without recourse for coping with labor. Also, the client *will* have to tolerate some labor before getting the epidural.

I agree with you, though, in cases like this, the epidural is a compassionate intervention.

[MrsMoe]

If an epidural does not take, they can redo it! My friend who had an epidural (twins delivered vaginal) had to have it redone, twice, so she was stuck a total of 3 times! But it did take, and she says she was so so glad she had it done, even though that had to stick her a few times.

While I am very very proud of my natural childbirth, I also know how horrid the pain was, and how tiresome it is. And I must admit, a part of me wondered if the labor would have been a lot more enjoyable without the discomfort a a pain like nothing I had ever felt before. And I wonder if my dangerously high blood pressure would have gone down with pain relief!

[NoraB]

Has the book An Easier Childbirth been suggested yet?

I've worked my way through most of the exercises and have come up w/ startling realizations about my fears (namely stuff coming from my own birth experience).

That book, in combination w/ BFW and lots of birth art may help tremendously.

A woman that accepts pain medication is not weak. She isn't lesser than a woman who has natural childbirth, nor should she feel ashamed.

Not all people have a spine of steal, and that is why epidurals are out there.

I definitely think epidurals serve a purpose, but it sounds to me like there is much more going on here than just pain issues. Being this terrified of pain and birth speaks of some past trauma. I think there's definitely a place for the compassionate use of pain medication in labor, but that pain coping techniques are going to be necessary regardless (not least b/c you have to get to a certain dilation before getting an epi). And since fear amps up pain, reducing the fear should help reduce the pain too. Epi is not the only or best answer.

[ZeldasMom]

Like mrsmoe, onlyboys, and norab i agree that epidurals have their place. I think it still makes sense to prepare for birth though. Even if you get a 2nd epi and it does take, it's not like this happens instantaneously. And when you're in out-of-control pain minutes seem like forever.

I like the analogy this article has about birth being like climbing a mountain and how there are different ways to do it and you need to pick the way that's right for you:
www.birthpsychology.com/birthscene/mothers3.html

The relevant passage starts out "Approaching childbirth is akin to stepping towards a mountain range, assuming that what lies ahead is not the ordinary terrain you are used to traveling. "

[crazy_eights]

Originally Posted by MrsMoe

If an epidural does not take, they can redo it! My friend who had an epidural (twins delivered vaginal) had to have it redone, twice, so she was stuck a total of 3 times! But it did take, and she says she was so so glad she had it done, even though that had to stick her a few times.

Even with a well placed epidural, the pain relief can be quite variable, not to mention that it can take a while to get relief. They are not going to be able to place it before she feels anything either! She needs to be prepared that even with an epidural, 'no pain at all' is not realistic.

[doctorjen]

I ordered that "An Easier Childbirth" book. It looks good. I liked the idea of doing a birth inventory - maybe that will help her determine what her issues are. Great ideas so far - keep 'em coming!

[lorijds]

Sometimes an epidural is not an option--if your lab work is abnormal, if you can't hold still long enough to place the epidural, if it doesn't take (sometimes there is a window of pain; you cna't place an epidural an infinite number of times; at some point you are going to run out of appropriate sites). I think that even if this woman has an epidural, when she goes into labor, she is going to have to deal with the pain for a little bit; you don't present at the hospital and get an epidural within five minutes. You have to check in, get your labwork done, get the IV started. Depending upon who does the IV (the nurse, the IV team), if the anesthesiologist is immediately available, is busy in the ER or the OR, or has to be paged from home, it can be literally hours from when you present until when you get your epidural. I have seen this first hand, I know it isn't even close to instantaneous. I don't disagree with you at all in the sense that epidurals are sometimes very appropriate. I work in an out of hospital birth situation, but I realize that there is a time and place for everything. I used to work with pregnant teens in state custody, and some of those ladies were better served by having an epidural than a natural childbirth. I appreciate that there are situations where an epidural can really help a woman have a great birth experience.

I think also that, even if she has an epidural upon the first moment of pain, it is appropriate for her doctor to be concerned about this all consuming fear. Who knows when this will again present itself, and in what manner? This sounds like a very serious issue, and I agree with all the suggestions--hypnosis, therapy, doula services, etc. I think counselling sounds very much in order here. I would recommend a counselor who has experience in dealing with sexual and birth trauma; some one with experience with rape and sexual abuse, specifically. Even if this woman has not experienced a sexual assault or childhood abuse, the feelings she has are very similar to those who have, and such a counselor might be better able to help her through her fear.

Good luck, Jenn! I feel so badly for her; I hate to think that she is spending her pregnancy full of this barely contained terror, rather than enjoying the growing life within. Poor woman! I hope she finds some reassurance and support that works for her.

Lori

[MrsMoe]

I didn't stop to think about the pain of "before an epidural" because that doesn't even come close to stage 3 labor pain... I know they can administer the epidural at 4 centimeters, but I read a recent article in a Pregnancy Magazine that stated (research from a well known medical university) that past assumptions that administering an epidural too early would slow and delay labor and wasn't advised... the stance is now different and research shows that early epidurals do not slow labor any more than epidurals given later in the birthing process.

I tend to be sympathetic to a degree, but, there will be some pain, even with an epidural, she needs to come to grips with it and prepare herself. There are many good options in the thread, such as a good coach, hypnotherapy, but it is going to hurt regardless, and if she gets herself all freaked out by it it will make the pain even worse. I do also wonder if her fears are that strong if there is an underlying issue?

[ldsapmom]

Does anyone have a good link to a brief description of the benefits of doula services?

http://www.dona.org/PDF/EffectsofBirthDoula.pdf

This may be helpful as well:

Finding A Non-certified Doula

Doulas of North America gives referrals of all its doula members who want their name to go out to the general public. Non-certified doulas are those members who have not completed Doulas of North America certification for a variety of reasons, including the possibility they have chosen not be certified or they are still completing the certification process. DONA is merely providing a listing of those members' names who have paid for membership. DONA recommends that you ask each doula about her training, experience and for references of previous clients. Referrals are done for a geographic area usually found by city and/or zip code.

Please send an email to [e-mail] listing your city and/or zip code. We will send a list of certified and non-certified doulas in your area.

Who knows, you might get even closer than an hour. And heving her boss read The Birth Partner would be a great idea.

Personally, I have no issue with a woman getting an epidural -- that's her choice -- her birth, not mine, right? That being said, it is wise to allow for the possibility of eith erone not being available, or one not taking effect, so you are wise to counsel her in that matter.

[Victorian]

nevermind

[girlndocs]

The other thing I was thinking is that even if she does get an epidural and even if it does work well, if her fears are deeply rooted she might still be afraid! And I am sure anybody hanging around here is familiar with how fear can hinder labor & birth.

[doctorjen]

I don't mean to keep repeating myself but I really practice in the middle of nowhere. I'm feeling more hopeful that I might be able to track down a doula, but there aren't any acupuncturists for miles! I know a lot of these suggestions are wonderful, but they are hard to promote around here. I live in an area where complementary health practices are not well known or respected. I can't even get women to try a chiropracter to turn a breech baby (and there is a Webster certified chiro an hour away) let alone consider anything more alternative. One mama with a breech baby told me she'd much rather have a cesarean than try anything crazy like a chiropracter!

[ldsapmom]

If you find one who is working on certification *keeping fingers crossed* she may do it for free or at a greatly reduced fee. Perhaps more "established," for lack of a better word, married, you know, older...know what I am trying to say? patients would be leery of the thought of a doula, but this mom sounds like she may be open to having a supporter.

You may also consider what kind of support her cousin could be. Perhaps with a little bit of training or support to the cousin, she could be really helpful to the mom.

Let me know if I can help at all -- I don't know if I can, but DONA-wise, maybe I could be of some help.