This feature is part of ELLE's 'Modern Motherhood Series' - exploring the shifting role of 'mother' in society and the women choosing to do things differently.
‘I think I always knew that I would die during childbirth,’ says Sophie.
‘I could envisage myself being pregnant. But I could never actually see the birth. It was like a blank spot – my brain wouldn’t let me imagine it; wouldn’t let me think about it.’
Severe birth-aversion is a real, if underdiscussed, phenomenon. It’s even got a fancy scientific name – tokophobia.
It’s different to fear, in the sense that to be phobic about something is debilitating, overwhelming. Most of us are a bit scared of new experiences, but we put ourselves through them without too much external help, whereas an untreated phobia would compel you to run in the opposite direction with your eyes closed and your fingers in your ears.
In the case of arachnophobia (spiders!), fleeing the scene might be an option with few grave consequences. In the event that you happen to be pregnant and phobic about the process of getting the baby back out of your body, the repercussions of trying to avoid it altogether could be quite serious for all parties involved.
The British Medical Journal (BMJ) estimates that anxiety disorders specifically related to pregnancy are present in over 17 per cent of women after they reach their first antenatal appointment. And tokophobia exists within that group.
‘This doesn’t really paint a full picture, though,’ says The Baby Show’s birthing expert Milli Hill, founder of the Positive Birth Movement and author of The Positive Birth Book.
‘I think many modern women are very scared of giving birth. Although most wouldn’t get a diagnosis of full tokophobia, they may still be feeling all kinds of things on the spectrum of fear, from anxious to absolutely terrified,’ she explains.
‘I don’t personally subscribe to the idea of ‘birth without fear’,’ she continues, ‘because giving birth is going to be daunting even for women who have done it before and feel confident about it. It’s not your average day! However, I think we do have a problem when so many women are absolutely dreading it, and the reason for this is because birth has begun to be accepted as traumatic, or even violating, by its very nature. We are beginning to lose track of the possibility that it can be anything other than dreadful,’ Milli finishes.
How Did We Get Here?
As the argument goes, birth is a ‘natural’ process and one that women’s bodies are designed to go through, so how did so many of us become scared of it, sometimes to the point of phobia?
‘First of all, there is what I call the ‘broken chain of wisdom',’ says Milli.
‘Several generations of women who have had traumatic, disempowering and downright violating birth experiences and who have literally nothing to pass on to their daughters other than fear and negativity.
‘Then, there are the TV shows like One Born Every Minute. These shows are interesting because they perpetuate the problem. They portray birth as an event in which women are largely passive and at the mercy of medical professionals. They hardly, if ever, show a woman having her choices being explained to her and making a decision about her care. This leaves the viewer with the impression that birth is something that is ‘done to’ women rather than ‘done by’ women, and that they don’t have any agency in the process.’
And for Sophie, 33-years-old and currently pregnant with twins after fertility treatment, it seems like it was exactly a combination of these two factors which contributed to her tokophobia.
‘There is a memory I have of myself,’ she says, ‘watching the film Nine Monthswith my mum. I must have been about 14-years-old and I remember turning to my mum during the birth scene and asking, ‘Is it really that bad?’ and her replying, ‘It’s worse.’ I looked at her then and said ‘I’m never going to do that. I would die.’
‘Many years later,’ she goes on, ‘and my sister’s experience of childbirth completely compounded my anxiety. During her first birth we actually lost her briefly. She stopped breathing, as a drug that she’d been administered had caused her to go into respiratory arrest. The doctors appeared to be giving up on her and focusing just on my niece. Luckily her husband wasn’t having any of it and screamed the hospital down, to save his wife. But my concept of birth after that was simply: danger.'
‘I developed this deep-rooted fear,’ she says, ‘that I would die during childbirth.’
So What Can We Do?
In Sophie’s case, where anxiety around childbirth escalates to extremes, the only way to begin to tackle the problem is through therapy. Let’s state this from the outset though: even if you are not experiencing a phobia-level of aversion and are just feeling a bit anxious, a good hypnotherapist or a course of cognitive behavioural therapy can be extremely effective in giving women the tools to manage their own experiences.
There are so many success stories, including Sophie’s.
‘I actually started seeing the hypnotherapist before we got pregnant,’ she says, ‘and the idea was floated that perhaps my fear of childbirth was one of the causes of infertility – my brain not letting me get pregnant.’
‘Therapy during my pregnancy has helped me to understand where my fears come from and has educated me that nothing will go to plan, but that I can be prepared for that and that I will have the skills to make decisions in the moment.
‘I am starting to see birth less as a medical emergency or a process that I won’t come out of alive and more as something that I am going to be monitored and mentored through. I am hoping to train my mind and body for the process. They always say you wouldn’t run a marathon without training, so I am trying to see giving birth that way. Trying to get myself to the fittest I can be and mentally prepared for it.
‘Oh and I definitely don’t want to know about other people’s birth stories any more,’ she concludes.
Are We Letting People Down?
Beyond more severe cases of tokophobia, if what Milli Hill says is true and a majority of pregnant women now feel scared to give birth, then we ought to look at why this is happening. We need to do something on a bigger scale, to reverse the mounting anxiety.
‘In the wider media there is so much negative messaging,’ says Milli. ‘Horror stories and phrases like ‘a healthy baby is all that matters’, implying that the experience of birth is unimportant as long as everyone gets out of it alive.
‘There is often also this language of permission in birth: ‘they let me/they did not let me’. This shocked me, that women were talking about birth in terms of what they were allowed or not allowed to do,' she continues.
This emphasis on a mother’s autonomy is surprisingly divisive. It seems obvious that we should get a say in our own childbirth process, but in practise, this doesn’t often seem to be the opinion of the others in the room. If there’s one other childbirth horror story we’ll be permitted to bring into the debate here, it’s that of Serena Williams. After her C-section, Williams felt short of breath. Fully aware that, with her history of pulmonary embolisms, this signalled trouble, she alerted a nurse to the situation. That nurse didn’t believe her, suggesting that her ‘pain medicine might be making her confused.’
Luckily, Williams persisted and they found the blood clots in her lungs, treated her and everyone ended up fine, but her story is telling. If even Serena Williams, fierce tennis superstar, aggressively autonomous, vanquisher of many men, is treated like a brain-addled dope during childbirth, what hope do the rest of us have?
Even in 2019, women aren’t being empowered during birth, despite the fact that it’s our bodies begetting another human and our lives hanging in the balance.
‘I started the Positive Birth Movement (PBM) seven years ago,’ explains Milli, ‘because it was the kind of thing I had craved when I was pregnant. It’s just groups of women coming together to talk to each other and listen to each other, share positive birth stories and share information about our rights and choices.’
As Milli says, we need to ‘inspire women to think about birth as something that they are strong enough to do and do brilliantly,’ but also that they have every right to make their own choices, at every stage.
What Can The Government Do?
At a higher level, there’s much more that needs to be done to help women engineer their own positive birth experiences.
For one, it is relatively rare that a pregnant woman will continue to see the same midwife more than once or twice during her pregnancy. In fact, often you’ll be seen by more than one midwife during childbirth. And there's a great deal of research to show that seeing the same midwife throughout reduces fear and anxiety.
‘Continuity of carer is something that the NHS is working towards as the result of a review called Better Births,’ reveals Milli.
‘If you know and trust your midwife, you will automatically feel more reassured and safer. Continuity of carer has also been shown in research to be 24 per cent less likely to experience preterm birth, 19 per cent less likely to lose their baby before 24 weeks gestation, and 16 per cent less likely to lose their baby at any gestation.
'Women were also more likely to have a vaginal birth, and fewer interventions during birth (instrumental birth, amniotomy, epidural and episiotomy). Women who received this type of care also reported greater satisfaction with information, advice, explanation, venue of delivery, preparation for labour and birth, choice for pain relief, were more positive about their overall birth experience, with increased agency and sense of control and less anxiety.’
The more you dig into the topic, the more awkward it is to watch the government falling short of its duty of care, not necessarily for women's safety during childbirth - the maternal death rate continues to decline rapidly - but for their overall wellbeing. Women need to head into childbirth with as much positivity as they can muster and a huge part of that is feeling empowered to make decisions about their own bodies, to have people in the room that they trust and to feel like they are being listened to. Continuity of carer seems like a ludicrously simple solution, but it's one that could radically change the experience.
The onus, however, isn't just on the NHS. It's on us too. If we lay off the scare stories just a little (your experience is valid, you should be heard, but perhaps watch how many people you tell it to?) and instead support other women by offering ways to be better educated for childbirth, to find a great doula or midwife to enlist, or just to feel more confident about speaking up about what they want for themselves, we'll be at least half of the way there.