what are you afraid of?

‘The only thing we have to fear is fear itself.’

‘A life lived in fear is a life half-lived.’

‘Feel the fear ... and do it anyway.’

Cliches abound about fear, more particularly about how to get over your fears: take a deep breath, square your shoulders, trust to luck, God, or gravity, and take the plunge into whatever it is you’re afraid of (exams, a really deep swimming pool, the Great Pit of Carkoon) . Less attention is directed at the source of fear: fear, instead, is dismissed as irrational, pointless, disabling, and ‘all in your head.’ While it may be true to say that fear is all of those things, I think it is no less true to describe fear as rational, focussed, enabling and physiological.  

Take childbirth, for example (somebody, please!)

I have to confess my innate cowardice and say that one of the things that put me off having children sooner was fear of childbirth (and also fear of losing my identity, autonomy and ambitions - but that is a story for a another post, one that I am more keen than ever to write after reading Anne-Marie Slaughter’s recent article on whether women can have it all in The Atlantic).

I don’t think I’m alone with my fears, either. According to the The Association for Improvement in the Maternity Services (UK) there has been an unquestionable surge in women's birth anxiety in the past 20 years. Evidence in the Journal of Obstetric, Gynecologic & Neonatal Nursing suggests that one in four women now currently suffer high levels of childbirth fear.

And it’s no wonder. We’ve all heard the horror-stories - unbelievable pain, bodies ripped to shreds, uncaring doctors, incompetent midwives - and felt our eyes water at the thought of pushing something pumpkin-sized out of something that is ... well, let’s just say, ordinarily not pumpkin-sized. Fear seems a pretty rational and sensible response to all this, if you ask me. 

A couple of years ago, however, I did indeed get pregnant and found myself in the position of having to face down my fears and find a way to manage them. Not only was the die now cast, but fear could also potentially make the birth process worse by increasing stress levels and producing unhelpful adrenalin. Talk about your vicious circle. 

Fear of the unknown was at least as much a part of it as fear of pain. As Western women tend to live in smaller nuclear families, have fewer children, have them in hospital, and have them later in life, many women (and men, for that matter) do not routinely experience the trials of childbirth as a ‘normal’ part of life. Instead, it is shrouded in mystery, often interventionist, and made to seem as an irruption into normal life. 

Rather than pretend I wasn’t afraid, I soon realised that I would need to face my fears. These included fear of painful natural labour and fear of epidural needles, fear of having an unwanted caesarean and not being strong enough to get through the birth. And that’s all without even starting on hospital food and institutional night-gowns.

Facing birthing fears is partly about demystifying the process. New Zealand has been a leader in championing midwife care, home births and natural births as a way of returning to the idea that childbirth is a normal part of life, and pregnancy is a state of health. Doulas - who are not midwives, but birthing support people who assist before, during and after birth - are common overseas, but are relatively new here. In the UK, mothers, doulas and midwives are using the internet and social media to help each other overcome their fears about childbirth. They mainly do this by telling each other their stories. Hearing what actually happened to other women in the recent past, rather than having your imagination run wild with worst-case scenarios and well-meaning yet ghoulish advice and anecdotes, has helped women who use this service face their fears.  

As I prepared for birth, I too heard birth stories. Some were of empowered natural births, without any form of intervention, of which the women who experienced them were immensely proud. Some were stories of grief, of ideals shattered and lives endangered. Some were stories of fears faced, and dealing with whatever twist the birth process took as it came up. Each was different, but each reminded me that women can do this. No matter how bad - and there were a fair few where something went pear-shaped - each of these women got through it and lived to tell the tale. Their talking cures not only helped them work through their experiences, but also helped prepare their audience, lifting their confidence and working on their expectations.

I have told my own tale elsewhere on this blog, so I won’t repeat it here. Instead, I offer some of my hard-earned tips for facing your fears:

• Don’t watch birthing videos (unless you really want to). Face it, as the mother you are not going to experience birth this way anyway, so what purpose will it serve, other than scare the bejesus out of you? 
• Admit you’re afraid (assuming you are, of course) and address what you’re afraid of. Positive affirmations are one thing - ‘every contraction brings my baby closer to me’ sounds nice and uplifting - but if you don’t really believe it because you’ve worried about how you’ll cope with that contraction - never mind the bloody baby - then it’s not going to be much use.
• Have some coping strategies up your sleeve. Even if things don't go according to plan, having some different things to try - acupressure, going for a walk, getting in a birthing pool, running screaming from the birthing pool - gives a sense of control in the face of the uncontrollable and affirms that you’re not completely helpless in the face of pain. 
• Surround yourself by people you trust, including partners / family / friends and the health professionals who will assist you. Knowing you have professionals in your corner who will let you know what’s going on, and give you space to make decisions is invaluable - they’ve been through this birth business before and have experience and insight that us first-timers don’t. Knowing you have family or friends in your corner who will support you when you need it, fight your corner if you can’t, and still be there after everything they witness is equally important.

My birth experience did not end up in any way being what I wanted or expected. But facing my fears to some extent, reminding myself that six billion people wouldn’t be here if women couldn’t do it, trusting the people around me to provide any help I might need kept the fear at arms’ length. I was not afraid during the labour and birth; although I had some decidedly mixed feelings immediately post-birth, fear wasn’t one of them! I can honestly say that the only time I felt afraid in the whole process was when I was taken to theatre for the second time and they were going to put me under a general anaesthetic. My fear was not that I wouldn’t or couldn’t deliver a baby or survive the pain - I already had - but that I would not wake up. 

At which point, I really had no option but to feel the fear and do it anyway ...

'women always over-dramatise their birth stories' (part two)

"Last time on ‘Dramatic Birth Stories’, the baby had just arrived, the mother was deeply shocked, and there was a big bloody mess everywhere."

Still reeling, I watched a small squishy blob being taken away from me over to where the paediatrician was poised ready to take her first measurements. My midwife, however, had other ideas and wrestled the baby off him to return her to me post-haste for some post-natal skin-to-skin.

My first thoughts were ‘how will I get the stains out of my clothes?’

Before I really had a chance to respond to her, the blob was off again to be weighed and measured and monitored.

Meanwhile, the registrar told me that I had been torn by the forceps and would need to be stitched up.

‘Um, ok,’ I believe I might have said.

I was wheeled off to surgery, midwife in tow, while my husband waited with the baby.

The surgery started well enough. I was awake and conscious throughout, as they decided to use a local anaesthetic that went thought the same place as the epidural. My midwife bounded into the operating room. Perching herself at my shoulder, we chatted inconsequentially to pass the time. Apart from the increasingly insistent tugging, which seemed to be endless (I mean, the area we are talking about is not exactly huge), and the anaesthetist who would not shut up asking me if I was okay all the time, the first hour or so was not too bad. Let me tell you, it is quite surreal to be discussing changes to Cardiff’s main shopping centre with one person, while three other people are trying to sew up your most intimate body parts, and another person is constantly informing you of every little change they are making to your drug levels. ‘Just tell me if you’re in any pain,’ he kept saying. ‘And don’t fall asleep.’

Then the beeping started.

There was a frenzy of activity.

‘What’s going on?’ I wanted to know. The registrars ignored me, as they forcefully started pushing and pulling my abdomen. Someone got on the phone to the consultant, who turned up at some point to inspect and offer advice.

‘Uterus won’t contract,’ was the curt response from someone in the room. ‘We have to massage it to stop the bleeding.’

There may’ve been drugs in my system, but that ‘massage’ hurt.

Then I started shaking uncontrollably, my teeth practically chattering themselves out of my head. ‘Shaking,’ I managed to get out. ‘Can you stop it?’

‘I’m okay with the shaking,’ said the anaesthetist. ‘You’re not in any danger.’

‘But my teeth won’t stop chattering,’ said I, stating the obvious.

Clearly this was a winning argument, as yet another body who had entered the room started drapping inflatable warming cloths around me. I gradually felt warmer, and some of my shaking stopped. But those teeth kept right on going. I’m surprised I have any left.

Meanwhile, the registrars had stopped assaulting my stomach and were finishing their needlework. My midwife had given up on the small talk and was stroking my hair and forehead. The anaesthetist had temporarily stopped badgering me to make incessant phone-calls to the lab to try and figure out whether or not I needed a blood transfusion. After a bit of back and forth, he decided I didn’t.

Eventually, it was all over. About four hours later, I was wheeled out into the recovery room. My husband sat waiting for me, with a small bundle next to him that I couldn’t really see properly. The nurses introduced themselves to me and asked my permission to take some colostrum to feed her. I said ‘yes’ and was squeezed and prodded a little more. I watched them feed the paltry results to her, but still have little recollection of what she looked like. I seemed to have hardly any strength for anything, other than to lie on the gurney and try and focus on what was happening around me.

My midwife asked if it was okay if she went home, so she could get some sleep. Fighting sleep myself, I said it was fine.

Some time later, and my sense of time is very hazy by this point, the registrar and anaesthetist burst back into the recovery room, saying we needed to go back to theatre right away. My vital signs were erratic and I hadn’t stabilised in the way they had hoped. A purple form was shoved in my face asking if they had my permission to perform an emergency hysterectomy in order to save my life.

‘Oh,’ I said, thinking this was starting to get very serious indeed. The doctors looked worried and wanted to move quickly. I signed the form with the small amount of strength I had left.

At this point, my husband intervened. He had been told next to nothing about what was going on, partly because of the state I was in, and partly because of the speed at which things were now starting to unfold. Through it all, he had literally been left holding the baby, and was terrified about what might happen. He asked the doctors if there were any other options. Feeling the urgency of the situation, they quickly hauled him out of the room, and, so I understand, told him that unless they took me back to surgery again, as soon as possible, I could bleed to death. Bleeding from the uterus is apparently very serious, and severe injury and death can result in a matter of minutes.

This all happened out of my earshot, of course. When they came back, he was wiping away tears. I didn’t have any time to say anything to him before I was wheeled off again. This time, they told me en route to the operating room, I would be put under a general anaesthetic.

‘I’m scared,’ I said.

‘Why?’ they asked.

‘I’m scared I won’t wake up.’

‘Don’t worry. A lot of people feel like that when they go under,’ they replied. I think this was meant to be comforting.

They put the mask over my face, and then pulled it away again. ‘Nothing’s happening,’ I said. ‘Don’t worry, it will,’ they said, putting it back on.

Before everything fell away, I heard that the consultant was now there, and they were discussing various options to staunch the bleeding.

Obviously, I did wake up again.

By this time, it was mid-morning the next day. Sun was streaming in the window of the birthing room. My husband was asleep in a chair by my bed. I felt a lot better than I had for a little while, although there were a lot of wires coming out of my arms and it hurt to move. I looked around this brave new world, and saw a little bundle with a large angry bruise on her cheek and cuts on her forehead. She was asleep.

It had been nearly twelve hours since I gave birth to her, and I had not held her properly once.

During the morning, both the registrar and anaesthetist from the night before came in to check on me. Not only was I now packed full of stuff to stop me bleeding, but I had had three blood transfusions. ‘But don’t worry,’ the anaesthetist said. ‘This doesn’t mean that the same thing will happen again if you have more children.’ Aside from the fact that the thought of having more children was not really uppermost in my mind at that point, I took from this that my uterus was still intact, if not exactly ready, willing and able.

We stayed in hospital for six more days, but I’ll end my story there.

I’ve tried to relate what happened to me - or as much as I can remember, at least - in as unadorned away as I can, lest I be accused of being ‘overly dramatic’. Even now, it still makes me feel very emotional to think about how serious things got very quickly.

All stories are a series of events that have been selected and put together in a certain way to create a certain effect. Until the last few months, narrating my story has been like a kind of therapy for me: I am incredibly grateful to the people who have listened to it, particularly the first time I told it. Telling it dislodged a lot of painful stuff, and certainly help me work through what, I’m sorry to say, was a very traumatic experience.

Contrary to my new acquaintance’s opinion that women competitively over-dramatise their birth stories to - I dunno - make themselves seem tougher, I think many women tell their stories in order to effect a kind of ‘talking cure’ to help them process the profound things that have happened to them.

As one of the hospital midwives said to me, as I bawled again after briefly telling yet another doctor what had happened to me, ‘it’s the ones who bottle it up that you have to watch.’

'women always over-dramatise their birth stories' (part one)

I was with a group of mothers recently and the subject of birth stories came up.

Not in the compulsive way it did in the early weeks after giving birth, when it felt like you had to talk about what had happened in order to process what a profoundly transformative - and, in some cases, traumatic - experience it was. For me, at least, that need has been well and truly met and I no longer feel like it is the first thing I have to know about another mother. Rather, it came up in the context of what some members of the group didn’t really want to talk about. Killing the moment to share a very personal experience and develop some sense of solidarity before it even began, one of the mothers said, ‘Oh no, not birth stories, they’re always so overly-dramatic.’

Another agreed, ‘Yeah, it’s like everyone always tries to outdo each other. Their experience is always worse than anyone else’s.’

In what was, perhaps, a gentle reproof, someone else pointed out that women might dramatise this experience because for many it is the most dramatic thing that has ever happened to them.

The moment passed as we agreed - or failed to disagree - not to share.

I couldn’t help but feel, however, that an opportunity had been missed. In some respects, birth stories are a female equivalent of war stories, and who would dare suggest to a returned serviceperson that the heat of battle is not dramatic? Having said that, I am also aware that the two women who were dismissive of birth stories were also newly pregnant for the second time, and may not have wanted to be reminded about what could potentially lay in wait for them in a few months’ time. There’s no denying that a bit of denial can sometimes get you through.

I’m aware that I’ve skirted around my own birth experience in my blog thus far. But with this criticism in mind, now is perhaps the moment. I will try to be as un-dramatic as possible, lest anyone feel that I am starting ‘BirthWars: an online competition to decide who is the toughest mother out there!’

It all began benignly enough on a sunny Tuesday afternoon.

I was a week ‘overdue’. During my midwife’s visit that morning we had discussed options for induction, including whether or not to induce or let nature take its course. As she got up to leave, I felt an unusual heavy sensation in my lower abdomen. I told her and she smiled and said ‘Oh good’.

I was starting to get seriously bored waiting around for the baby to put in an appearance. I had even started a 1000-piece puzzle of a Worcestershire half-timbered cottage to help pass the time. After my midwife had left, I returned to the puzzle and was congratulating myself on having got all the edge pieces in place, when, at about 2pm, I felt something give. Wondering what it was, I went to the bathroom, in what I can only say was the nick of time. Within seconds of getting there, there was a positively diluvian outpouring that went absolutely everywhere. ‘Guess I won’t be finishing the puzzle, then,’ I thought to myself as I started mopping it up.

Feeling excited and more than a little damp, I phoned my midwife and told her the news. ‘Oh good,’ she said, and instructed me to call her again when the contractions became stronger and more regular. I then phoned my husband, who was also excited and jumped in a taxi to come straight home.

There we were, braced for action, waiting for those contractions to get stronger. And waiting. And waiting. And waiting.

‘That was one!’ I cried, trying to feel like the ripple of discomfort I had just experienced was actually starting to test me. ‘How long has that been since the last one?’

‘Mmm, a while,’ said my husband, ‘maybe 20 minutes.’

‘Oh,’ I said, disappointed. It wasn’t going to be one of those quick labours, then.

The afternoon passed fairly uneventfully. We made sure my bag was packed and got out the combs, hot water bottle and swiss ball. And, anti-climatically, nothing much happened. It was almost Beckettian.

By bedtime, the contractions were a little stronger - like moderate periods pains - but still not particularly unbearable. By 2am, they were getting stronger and reasonably regular, although their regularity was probably at least as much a product of my wanting them to be regular than their actual intensity. My husband kept dozing off in the middle of doing acupressure on my lower back. I kept having to prod him awake, but, to be honest, felt that I could handle this level of pain by myself. ‘Hmmm, maybe this labour thing is not so bad after all,’ I thought to myself sleepily. As the pain from the contractions marginally increased, I turned over in bed to try and get more comfortable.

And then they stopped all together.

Disappointed, I too must’ve nodded off, because next thing I knew it was 6am.

Wondering what on earth was going on, I called my midwife. Almost accusingly, she told me that she had been up most of the night watching trashy late night TV, ready at a moment’s notice to make a dash to the hospital. ‘Sorry,’ I apologised. ‘I just didn’t want to wake you up, when nothing much was happening.’

She then asked me if I’d like to go the hospital.

‘Yes,’ I said, with relief, thinking that once we got there, something had to happen.

Wrapped in a towel in case there were any more leaks, me, my husband and the hospital bag arrived at the hospital. I think even the taxi driver was disappointed that it wasn’t an adrenalin-packed race to get there.

On arrival, we sat in the waiting room, while someone cleaned up one of the birthing rooms for us. Sipping my tea, I had visions of blood-soaked walls, and had to remind myself that I was actually in labour.

My midwife explained to me that eighteen hours was as long as the hospital was comfortable letting labour continue once a woman’s waters had broken, in case of infection. By 9am that morning, I had nearly met the deadline at only one centimetre dilated. I had barely even broken a sweat. It was time to induce.

‘OK,’ I thought. ‘Now we’re getting somewhere.’

I was hooked up to a syntocinon drip, which stimulates contractions, and my midwife increased the doses at 15-minute intervals. ‘This is not so bad’, I thought, propped up on my pillows. When the dosage hit maximum, however, I was definitely starting to feel it. ‘Now!’ I cried to my husband when the frequent and strong contractions came so he could get his thumbs into position. For a while, I managed to cope with the now-quite-decided pain with acupressure and determination. When an exam by the registrar found that I was still only one centimetre dilated I burst into tears, not from the pain so much, but from the frustration. All that work and I was getting nowhere.

My midwife started making cryptic remarks that I interpreted to mean she thought I needed to soldier on. Still in the grip of profound contractions, I looked at her like she was insane. She then said that she’d leave my husband and I alone to discuss it. Once she’d left the room, he told me that she had in fact meant that I should have an epidural. ‘Oh,’ I said, feeling like a dunce. ‘OK.’

Feeling relieved that I didn’t have to tough it out, the anaesthetist and a range of other bods that I can’t really remember came in to sort out the epidural. ‘Oh’, she said, trying to insert the gigantic needle between my vertebra, ‘that’s odd.‘ For the record, these are words that you don’t want to hear when you’re in this kind of situation. This was quickly followed by ‘the needle doesn’t seem to go in very far’, which is number two on my list of things you don’t want to hear in this kind of situation. After some back and forth, she decided that the answer was that I simply must have the spinal column of a young east Asian woman (really) and that was that. With all this carry-on, I was thinking to myself that it would be just my luck that the epidural wouldn’t work, and I’d have to tough it out anyway.

Fortunately, I was wrong (again) and the drugs did work. Within half an hour or so, the contractions subsided to a dull roar. I spent the rest of the afternoon and evening, relaxing in my pillows eating sandwiches and listening to jazz. Labour? Ha!

About dinner-time, when my midwife said that I shouldn’t eat any more food, the registrar announced that I was now ten centimetres dilated, and that the baby would probably be born that night. They’d be taking bets on the side for early the next morning, but, with a bit of luck and a following wind, she’d be there by midnight.

Enough of this lounging around like I was on holiday: it was now time to push. My midwife reduced the amount of drugs going in, so I could feel enough to push. Bracing myself against her and husband, a foot on each hip, I bore down with all the strength I could muster. After a few pushes, my midwife said she had seen the baby’s head - the so-called ‘miwife’s peep’ - and my feelings of excitement returned. Not long now. Or so I thought at the time.

An hour and a half of pushing later, my baby was still proving elusive.

From what I understand - and my recollection of some of these events is becoming hazy - she stopped moving and her heart-rate became erratic. The registrars - all of whom looked about 12 - trooped back in: it was time to bring in the heavy artillery. Forceps, with the possibility of an emergency casearean if they didn’t work.

‘Um, OK,’ I said.

An episiotomy incision was duly made. The tongs were produced.

I pushed. The registrar pulled.

And then there was a baby.

Feeling profoundly shocked and violated beyond my capacity to describe it, I remember thinking, ‘what the f*** have I done?’

It was then that things started to go wrong.

Catch the next thrilling installment in ‘birth story: part two’.